Arkansas Medicaid work requirements add new option: phoning it in
By Harris Meyer
December 12, 2018 - Modern Healthcare
Facing mounting
criticism over its Medicaid work requirement, the Arkansas Department of Human
Services announced Wednesday that enrollees will be able to report their
compliance with the mandate over the phone rather than solely through an
internet portal.
Starting Dec. 19, adult who aren't disabled and enrolled
in the Arkansas Works Medicaid expansion program will be able to report by phone
to DHS or their Medicaid managed-care plan on their compliance with the state's
so-called community engagement requirement. Enrollees will be able to call the
state from 7 a.m. to 9 p.m. seven days a week.
The state requires adult
enrollees who aren't disabled and ages 30-49 to put in 80 hours per month of
work, job training, classwork or volunteer activities to continue receiving
coverage. Enrollees ages 19 to 29 will have to start reporting in
2019.
DHS said staff working the new help line will assist beneficiaries
in meeting their 80-hour requirement and refer them to helpful services.
"We are six months into this new Medicaid demonstration program, but
wanted to take the time now to (assess) what areas we need to shore up or
improve," DHS Director Cindy Gillespie said in a news release.
As of the
end of October, nearly 13,000 Arkansans had been dropped from coverage due
to not reporting that they met the community engagement requirements for three
months. As many as 6,000 more people, who had not met the reporting requirement
for two months, may lose benefits as of the end of November.
The rocky
Arkansas rollout, with its substantial coverage losses, has alarmed state
officials, providers, Medicaid plans and patient advocates in other states that
are about to start or are considering similar work requirement programs. It's
the first-ever state to require Medicaid beneficiaries to work as a condition of
coverage.
Arkansas is the only one of the five states that have received
a CMS waiver to impose a Medicaid work requirement with an internet-only
reporting system. That has been partly blamed for the growing number of
Arkansans who have been disenrolled for failure to report that they met the
requirement.
As many as one-third of Arkansans who are subject to the
work requirement may lack internet access, researchers say. In addition,
healthcare providers and advocates say the state reporting portal is difficult
to log into and use.
The Medicaid and CHIP Payment and Access Commission
recently urged HHS Secretary Alex Azar to halt disenrollments pending closer
examination of the structure of Arkansas' program.
CMS Administrator
Seema Verma recently indicated her agency was closely watching the Arkansas
experience and that the state might make changes.
"We're in discussion
with them to make sure that the implementation is going smoothly," Verma said during a news briefing last month. "We are
looking closely at the people that have left the program to understand the
reasons why they have left the program, and I think that's going to give us a
lot of lessons learned."
MaryBeth Musumeci, a Medicaid policy expert at
the Kaiser Family Foundation who has studied Arkansas' work requirement rollout,
said adding a phone reporting option is "somewhat positive" but that much will
depend on how easy the phone system is to navigate. She tried calling the
toll-free line Wednesday and found that it appears to have a lot of layers of
phone tree features.
But the biggest problem she and her Kaiser
colleagues found is that most Arkansas Works enrollees don't even know they have
to report their hours of community engagement.
"Everyone agrees that
both the state and the Medicaid plans have done quite a bit of outreach," she
said. "But it hasn't been as effective as hoped in reaching people."
The
CMS and the states have to find a way to enable Medicaid enrollees to report
their community-engagement activities "that doesn't require extraordinary
efforts by individuals," said Joseph Antos, a conservative health policy expert
at the American Enterprise Institute.
Kevin De Liban, an attorney with
Legal Aid of Arkansas, which filed the suit challenging the Arkansas waiver,
said adding a phone reporting option is "like fixing a leaky faucet on a sinking
ship."
The state's work requirement has caused thousands of people to
lose access to physician and counseling appointments and prescription drugs, and
has caused them to miss work as a result, he added.
"Those are the real
costs of this disastrous program," he said. "Instituting a phone line that
probably won't work very well isn't fixing the real issue."
Meanwhile,
U.S. District Judge James Boasberg in Washington is hearing a lawsuit
challenging the CMS' approval of the Arkansas Medicaid waiver permitting the
community engagement requirement. The U.S. Justice Department and the state of
Arkansas recently filed answer briefs in the case defending the
waiver.
In June, Boasberg invalidated the CMS' approval of a similar
requirement waiver in Kentucky on the grounds that the agency did not adequately
consider its impact on coverage. In response, the CMS held a new public comment
period on the Kentucky waiver and recently re-approved it in identical form.
Another legal challenge is expected.