On Tuesday, the Arkansas Department of Human Services released its monthly numbers for Arkansas Works, the program that provides Medicaid-funded health insurance to low-income adults in the state.
From March 1 to April 1, enrollment in the program declined by about 3,500, the report shows. There were 281,033 beneficiaries covered as of the beginning of April, down from 284,670 as of the beginning of March.
The decrease is not due to the imposition of work requirements for Arkansas Works beneficiaries, which were approved by federal Medicaid authorities earlier this year but will not go into effect until June.
Still, the most recent decrease is part of a longer-term trend driven by policies enacted by Governor Hutchinson and DHS Director Cindy Gillespie. Arkansas Works enrollment decreased by over 10 percent from the beginning of 2017 to the beginning of 2018.
Hutchinson, who inherited the Obamacare-funded program from his predecessor, has fought to preserve Medicaid expansion in Arkansas over the objections of some lawmakers within his own Republican Party, but he’s also vowed to make the program more restrictive. In January, Hutchinson and Director Gillespie announced the Arkansas Works population and other Medicaid populations both declined significantly over the previous year, from 344,289 beneficiaries on Jan. 1, 2017 to 285,564 on Jan. 1, 2018. The number of Arkansans on traditional Medicaid — which covers populations such as children, the elderly and the disabled — also declined over the same period.
At the time, Hutchinson said the reduction was due to an “extraordinary effort by DHS in improving the accuracy of the Medicaid rolls” in terms of reviewing and processing cases. DHS had also worked with the Department of Workforce Services to ensure “that those that are on Medicaid are actually supposed to be there,” he asserted. He also said that a strong economy and a low unemployment rate were helping people move off Medicaid.
It is not clear, however, how many of the individuals removed from Arkansas Works are gaining insurance from an employer or another source and how many are simply going without coverage. Arkansas’s rate of uninsured was once among the highest in the nation, but it experienced the nation’s second largest decreases in that metric over the last several years, mostly due to Medicaid expansion. (The largest per capita decrease was Kentucky — another red state that expanded its Medicaid program under the Affordable Care Act but is now attempting to scale back coverage by imposing work requirements.) U.S. Census Bureau data from 2017 showed Arkansas’s rate of total uninsured declined by 50 percent between 2013 and 2016.
The most recent DHS report paints a less straightforward picture of enrollment trends in traditional Medicaid (that is, everyone else in the Medicaid program excluding the “expansion population” of low-income adults). From January 1 to April 1, the number of adults and children in traditional Medicaid grew — from about 232,000 to 235,000 for the former group and from about 414,000 to 418,000 for the latter. (ARKids, the state’s insurance program for children from low-to-middle-income households, is included.) But, those numbers have fluctuated over the last several months. Partly because of how DHS processes applications and removes ineligible beneficiaries from the rolls, the number of enrollees rises at the end of every month and falls sharply at the beginning of every month.
Overall Medicaid enrollment in both expansion and traditional Medicaid was 934,747 as of April 1 — around 1/3 of Arkansas’s entire population.
This reporting is made possible in part by a yearlong fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.