Sanders: Arkansas will seek federal OK for new Medicaid work requirement

This story was updated at 10:40 a.m. on Feb. 16, 2023.

Arkansas is seeking a waiver from the federal government in order to require adult Medicaid recipients to work, volunteer, go to school or receive workforce training in order to receive certain health care coverage, Gov. Sarah Huckabee Sanders and Human Services Secretary Kristi Putnam announced at a press conference Wednesday.

Enrollees in the state’s Medicaid expansion program who do not fulfill this requirement would not lose coverage, unlike last time Arkansas enacted a work requirement for the program, Sanders said.

One of Sanders’ promises while campaigning last year was to work with the state Legislature to submit a new Medicaid work requirement to the federal government. She has also said repeatedly that she wants to reduce “government dependency” in the state.

“Every industry group that I’ve met with has told me the same thing repeatedly: they cannot find enough workers here in Arkansas,” Sanders said at the press conference.

Sanders and Putnam expect to publish a draft of the state’s request for a Medicaid waiver from the federal Centers for Medicare and Medicaid Services (CMS) on April 23, and there will be a 30-day public comment period before submitting the request on June 1, Putnam said.

The new program would go into effect Jan. 1, 2024 if the state receives the waiver, and Sanders said she is confident CMS will accept the request.

Able-bodied adults who do not meet the work requirement would receive fee-for-service Medicaid coverage instead of a qualified health plan, Sanders and Putnam both said.

Qualified health plans meet the federal Affordable Care Act requirement for “minimum essential coverage” and follow federal limits on deductibles, copayments, and out-of-pocket maximum amounts. Under fee-for-service coverage, the state pays health care providers for their services.

The proposed work requirement should incentivize Arkansans to seek the more robust benefits and “additional social supports” of a qualified health plan, Putnam said.

“State law allows DHS to use qualified health plans enrollment as an incentive to foster economic independence,” she said.

Arkansas’ previous Medicaid work requirement, enacted in 2018, exempted people who were over 50 years of age or had dependent children. Even so, the Arkansas Works program cut 18,000 people from Medicaid coverage.

A federal judge struck down the work requirement in 2019 after the Southern Poverty Law Center filed lawsuits against it and a similar proposal in Kentucky. Sanders said the new proposal “is fully compliant with previous court rulings.”

Arkansas received a new Medicaid waiver in December 2021 to revamp the program, now called ARHOME. It does not include a work requirement.

Putnam was one of the strongest proponents of Kentucky’s proposed Medicaid work requirement when she worked for the state’s Cabinet for Health and Family Services from 2016 to 2019. Sanders appointed Putnam to lead the Arkansas Department of Human Services in January.

“We very much want to provide opportunity and access and, as a state, move from perpetuating poverty to empowering economic independence,” Putnam said Wednesday.

Currently, non-disabled adults between the ages of 19-64 with incomes up to 138% of the federal poverty level ($18,754 for an individual and $38,295 for a family of four) may qualify for ARHOME.

Other workforce enhancement proposals

Arkansas currently has a work requirement for adult recipients of the Supplemental Nutrition Assistance Program (SNAP), commonly referred to as food stamps, with the same exemptions as the former Arkansas Works program.

Additionally, a bill that would require able-bodied adults to work or volunteer part-time to receive federal housing assistance passed the House earlier this month. House Bill 1196 would exempt people with disabilities, parents of children under 5 years old and participants in drug and alcohol treatment programs.

Opponents of the bill have said it conflicts with federal law, which already requires adult residents of public housing to work or volunteer for eight hours per month.

House Bill 1196 might create “red tape” as a barrier to housing for Arkansans who meet the work requirement or qualify for exemptions, said Laura Kellams, former interim co-executive director of Arkansas Advocates for Children and Families, while speaking against the bill before the House City, County and Local Affairs Committee on Feb. 1.

Legislative Republicans are expected to introduce a wide-ranging education bill this week that Sanders introduced last week at a press conference. The bill would include a dual diploma program to help prepare students for the workforce.

Sanders also created a “workforce cabinet” via executive order Feb. 9 “to facilitate an all-of-government approach to the workforce readiness problem,” she said Wednesday.

The workforce cabinet will help compose the state’s request for a Medicaid waiver from CMS, Putnam said.

When asked about studies that have shown work requirements for public benefits to be ineffective, Sanders repeated her statement about encouraging work and discouraging government dependency.

“Anytime we can offer pathways and incentives, we’re going to look for that,” she said. “We think this is an innovative way to do that but also make sure people have access to care.”

The advocacy group Arkansas Community Organizations disagreed in a statement Wednesday evening. The group petitioned DHS last week to improve both the coverage and accessibility of Medicaid in Arkansas.

“Instead of imposing work requirements on ARHOME, let’s make traditional Medicaid better by offering better coverage,” the organization wrote. “Let’s improve our enrollment and renewal system. Let’s have navigators at every county DHS office to help people enroll and renew and troubleshoot problems.”

The Democratic Party of Arkansas released a statement Wednesday afternoon opposing Sanders’ announcement and saying the new work requirement “will hurt Arkansans and fail in the courts.”

“A decade ago in Arkansas, Republicans and Democrats united to make historic gains in expanding health insurance to more than 300,000 Arkansans,” strategy director Will Watson said. “Now, Gov. Sanders plans to waste our state’s time and money with a mean-spirited tactic already rejected by a federal judge.”