Implementing Work Requirements Caused Health Premiums to Increase for Arkansans

Arkansas’s Medicaid work reporting requirements not only kicked 18,000 Arkansans off their health insurance, it also raised premiums on some Arkansans who purchased their insurance through the state’s marketplace.

Arkansas has faced widespread criticism for more than two years because of its implementation of work reporting requirements on certain Medicaid beneficiaries. Between September 1 and December 31, 2018, more than 18,000 Arkansans lost their Arkansas Works health coverage as a result of this experiment. Studies have shown that most of these Arkansans were working or exempt, but because of the complexity of the requirements were unable to report their work hours or exemptions correctly. U.S. District Judge James Boasberg’s ruling in March 2019 stopped Arkansas from continuing to implement the requirement. It was appealed by the U.S. Department of Health and Human Services and heard in the U.S. Court of Appeals for the D.C. Circuit, from which a ruling is expected any day.

Last month, the Government Accountability Office (GAO) released a report examining the costs of implementing these work reporting requirements in several states, including Arkansas. The major finding for Arkansas: we spent an estimated $26.1 million implementing a program that took health insurance coverage away from more than 18,000 people.

There is evidence, however, that the cost of implementing the work reporting requirement was greater than $26.1 million and that some of that cost was passed on to everyday Arkansans who purchased their health insurance through the state’s health insurance marketplace, by way of increased premiums.

Page 22 of the GAO report states that, “In Arkansas, where beneficiaries receive premium support to purchase coverage from qualified health plans on the state’s health insurance exchange (marketplace), plans were instructed to include the costs of administering work requirements in the premiums, according to Arkansas officials. State officials and representatives from a qualified health plan we spoke with could not provide the amount that the state’s premium assistance costs increased as a result.” Joan Alker, Executive Director of the Georgetown Center for Children and Families points out one of the report’s footnotes in a blog post published November 20. The footnote states that, “In addition, we spoke with representatives of a qualified health plan in Arkansas that serves Medicaid beneficiaries who said that administering work requirements would increase non-Medicaid members’ premiums.”

The increased premium cost is not included in the $26.1 million that was estimated by Arkansas as the amount it took to implement the work reporting requirements.

This information identifies yet another way that Arkansas’s failed experiment with work reporting requirements was devastating for Arkansans. It added another barrier to coverage for low-income Arkansans and increased premiums for even non-Medicaid members. While it may be years before the complete damage of these requirements is known, no positive argument exists for increasing the costs of health insurance premiums for Arkansans just to take away coverage from more of Arkansas’s most vulnerable populations. In the unlikely event Judge Boasberg’s ruling is overturned, Arkansans will need to work hard to advocate against the re-implementation of the work reporting requirement on Arkansas Works enrollees.