A nonpartisan commission on Thursday told the Trump administration it is “highly concerned” about the number of Arkansans who were kicked off Medicaid coverage because they failed to report work hours or community engagement.
Nearly 8,500 Arkansans have been knocked out of coverage for failing to report compliance, raising eyebrows at the Medicaid and CHIP Payment and Access Commission — or MACPAC — which makes recommendations to Congress and the Health and Human Services Department.
“The low level of reporting is a strong warning signal that the current process may not be structured in a way that provides individuals an opportunity to succeed, with high stakes for beneficiaries who fail,” the commission said in a letter to Seema Verma, administrator of the Centers for Medicare and Medicaid Services, and key lawmakers on Capitol Hill.
MACPAC — the sister agency of MedPAC, which advises on Medicare — said state officials should stop kicking people off the rolls until steps are taken to promote awareness of the rules and improve compliance.
The administration is letting several states impose work requirements on certain Medicaid enrollees, saying it’s a good way to get people up and off the government dole.
Arkansas has already implemented its program, though New Hampshire, Indiana and Wisconsin have gained permission, while a fifth — Kentucky — had to put its requirements on hold, after a federal judge said the federal government cut corners in reviewing its waiver request.
MACPAC said it wasn’t critiquing the merits of work requirements championed by President Trump.
Rather, it is worried that people are losing coverage because they lack the awareness or ability to comply with hastily implemented rules. Arkansas implemented its requirements in June, after winning approval in early March.
MACPAC says that might have been too fast.
“Past state experiences with major program innovations, such as managed care implementation, suggest that more time may have been needed to develop a robust education and outreach strategy,” the commission wrote.
Arkansas requires people to report their compliance through an online portal. That worries MACPAC, which pointed to a lack of internet access and the “multi-stage process” of setting up an account before entering data.
The state provides reporting assistance at county offices, though MACPAC says it’s unclear if many people are using that service.
Low internet access also hampered awareness efforts, the commission said, since Arkansas’s educational efforts are mainly available online or through social media.
MACPAC’s concerns will fuel critics who say the Trump administration’s decision to promote work requirements flouts Medicaid’s core mission of providing insurance, while throwing bureaucratic hurdles in front of that coverage.
People kicked off the rolls will end up sicker, making it hard for them to work, those critics say.
The administration says it’s the other way around, and that forcing people to work lifts them up and makes them healthier.
Ms. Verma says requiring enrollees to engage in their communities is the best way to break through the “soft bigotry of low expectations” set by the Obama administration, which rejected work requirements.
MACPAC, however, said CMS may not be prepared to evaluate whether the waiver programs — effectively, state experiments — are working well.
“The short implementation timeframe in Arkansas may have contributed to both beneficiary reporting challenges,” it said, “and the absence of sufficient measures and data to interpret early results and guide adjustments.”
The state of Arkansas took issue with MACPAC’s review in a letter dated Oct. 31, saying it regularly tracks the downstream effects of dis-enrollment on residents — such as their ability to find other coverage — and has used door-to-door visits to inform enrollees of their obligations. It said 95 percent of enrollees reached by the state’s call center did not indicate that a lack of internet access or computer literacy had been a hurdle.
Arkansas also said MACPAC appeared to single their state out, without allowing officials to air out the issues in a public hearing.
“For MACPAC to attempt to establish itself as a monitor over individual state Medicaid programs is a new and slippery path that should be reconsidered,” Dawn Stehle, Medicaid director for the Arkansas Department of Human Services, wrote to MACPAC.
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