Arkansas Aims to Impose Work Requirement on ‘Able-Bodied’ Medicaid Beneficiaries

Gov. Sarah Huckabee Sanders speaks after taking the oath of office in Little Rock, Arkansas, on Jan. 10, 2023. AP Photo/Will Newton

Arkansas Gov. Sarah Huckabee Sanders is asking the Department of Health and Human Services (HHS) to allow the state to impose a work requirement on certain Medicaid beneficiaries.

“I am submitting a waiver on behalf of the state of Arkansas to allow us to implement a work requirement for all able-bodied, working-age recipients of Arkansas’ Medicaid expansion program, ARHOME,” said the Jan. 28 letter to HHS secretary nominee Robert F. Kennedy Jr. “There are 220,000 able-bodied, working-age adults in Arkansas receiving free health care courtesy of the taxpayer, costing us more than $2.2 billion each year—and growing.

“Of those recipients, estimates show nearly 90,000 have no job. Most Arkansans work hard to pay for their health insurance while these healthy adults do not work at all. That is a backward, broken system.”

The governor said that under the first Trump administration, Arkansas had implemented a work requirement for ARHOME but that “federal litigation halted our progress.”

In March 2018, Arkansas became the third state to implement such a requirement. The state mandated that people work or participate in job training or job search activities for at least 80 hours per month as a condition of receiving Medicaid. Those who failed to meet the requirements for three months of a plan year were to be blocked from re-enrolling in the program until the following plan year.

However, in March 2019, a district judge blocked Medicaid work requirements in Arkansas. In his ruling, the judge wrote that the state’s work requirement had caused about 16,000 Arkansans to lose Medicaid coverage.

In her letter to Kennedy, Sanders said her waiver cuts down administrative hurdles and other challenges faced by legitimate Medicaid recipients while still ensuring that the program serves “as a safety net rather than a poverty trap.”

The governor argued that work not only provides a steady paycheck but also builds responsibility and reduces problems such as crime, hunger, and fatherlessness that affect the state’s poorest communities.

“President Trump declared it in his inaugural address: A new American golden age has begun. But our country cannot unleash unprecedented prosperity if able-bodied, childless adults sit on the sidelines. And we won’t slash our deficit if our welfare programs pay people to stay on the sidelines,” she said.

Waiver Amendment

Before 2010, Medicaid was a program only available to elderly people, individuals with long-term intellectual or physical disabilities, parents or caretakers of dependent children with household income near or below the federal poverty level, and low-income children, according to the waiver request document.

But in 2010, President Barack Obama’s Affordable Care Act created a new group eligible for Medicaid—able-bodied working-age adults.

In Arkansas, these individuals are covered under the ARHOME program, which provides Medicaid coverage to more than 220,000 able-bodied adults with incomes at or below 138 percent of the federal poverty level.

The waiver would add a Pathway to Prosperity amendment to ARHOME that would apply to individuals aged 19 to 64 whose incomes are up to 138 percent of the federal poverty level, who are eligible for ARHOME, and who are covered by a Qualified Health Plan (QHP).

Under Pathway to Prosperity, the Arkansas Department of Human Services (DHS) will assess whether beneficiaries are “on track” to meet their personal health and economic goals.

If an individual is identified as “not on track,” the department will assign a “success coaching resource” to the person to determine whether he or she is able to benefit from additional support. Success coaching aims to improve an individual’s health, employment, advancement, learning, and community engagement. This can also lead to a personal development plan (PDP).

“Individuals who refuse to cooperate with DHS and decline to use services and incentives covered by QHPs will have their ARHOME coverage suspended,” the document said.

“ARHOME benefits can be restored if the individual subsequently chooses to engage in success coaching to get ‘on track’ with their PDP.”

Arkansas’s waiver request came as Kennedy appeared at a confirmation hearing before the Senate Committee on Finance on Jan. 29. The committee will vote on whether to advance him to a full Senate floor vote.

Reuters contributed to the report.