Arkansas Governor applies to CMS for waiver to implement work requirements for Medicaid


Arkansas Governor Sarah Huckabee Sanders sent a section 1115 waiver request to the Centers for Medicare and Medicaid Services (CMS) last Tuesday, January 28th, requesting permission to implement work requirements for able-bodied Medicaid recipients aged 19-64. 

Section 1115 of the Social Security Act allows for states to request approval from the CMS to waive certain federal requirements and details so they can implement their Medicaid programs with state-specific variations, such as work requirements. The federal government does not set work requirements for Medicaid.

Arkansas’ proposed waiver, which is titled Pathway to Prosperity, would implement work requirements differently than the 2018-2019 Arkansas Works program, the state’s Medicaid work requirements waiver program approved by the CMS under Trump’s first administration. For example, under Arkansas Works, individuals who fell out of compliance with the program’s work requirements were unenrolled from Medicaid. Under Pathway to Prosperity, individuals who are not on track to meet the work requirements would have their benefits suspended for the rest of the calendar year or until they indicate their intention to become on track for the program’s work requirements. 

Other features of the proposed Pathway to Prosperity program include:

  • the establishment and monitoring of personal development plans for individuals, 
  • focused care coordination to connect unemployed individuals with resources such as career training and transportation, and
  • the discontinuation of the monthly manual reporting requirement under Arkansas Works, in favor of the use of data matching and/or regular audits instead. 

The proposed amendment does not set a minimum number of hours that individuals must work per month to be considered on track and receive benefits. Instead, the program focuses on personal development plans to increase individuals’ wages and hours worked. 

The waiver request to CMS from the Governor’s office states that the proposed Pathway to Prosperity program is an improvement upon Arkansas’ previous attempt to implement work requirements and incorporates changes based on lessons learned in 2018 and 2019:

“Arkansas and Kentucky were the first states to receive approval for implementing Medicaid work and community engagement requirements for their adult expansion populations. Both states were ultimately sued by plaintiffs who alleged they experienced harm from the requirements. This Pathway to Prosperity amendment reflects lessons learned from Arkansas’s efforts in 2018-2019 to require working-age, nondisabled adults to participate in workforce activities as a condition of maintaining eligibility for Medicaid under the expansion program, then known as “Arkansas Works.” Assessments of Arkansas Works showed that many people did not know whether they were subject to participation requirements and, if they were, what they needed to do monthly to demonstrate compliance.”

The Arkansas Advocates for Children and Families argued in a statement that Medicaid isn’t a workforce-incentive program and that the lesson to be learned from Arkansas Works is that work requirements don’t reduce poverty:

“What we learned from the flawed experiment was that work requirements don’t reduce poverty, don’t help people work, and don’t improve people’s employment outcomes. Instead, implementing work requirements led to administrative barriers and red tape, resulting in tens of thousands of people losing their health insurance… The sole purpose of Medicaid is to provide health insurance for Arkansans with low incomes. It is not a workforce incentive program. This was affirmed in the 2019 legal ruling that struck down the state’s ill-fated attempt to impose work requirements. Instead of creating costly and punitive requirements under the guise of encouraging people to work, our leaders should work to reduce barriers to care.”

Background

Arkansas was granted section 1115 waivers twice before: once under the Obama administration and once under the first Trump administration. 

The Obama administration granted the state’s waiver but on the condition that work requirements be removed from the program. At that time, Health and Human Services (HHS) determined that work requirements for Medicaid undermine access to care and do not support the objectives of Medicaid. 

Under the first Trump administration, CMS approved Medicaid work requirement waivers in 13 states including Arkansas. Of the recipients of these section 1115 waivers, only Arkansas fully implemented its program before the Biden administration directed CMS to withdraw all approved waivers.

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