The New York Times is the latest to focus unflattering attention on Arkansas Gov. Asa Hutchinson’s Medicaid work rule, which has already eliminated 4,300 from medical coverage. Many thousands more are likely to come. One big problem: People don’t know the rule exists.
The article eviscerates the state’s defense of the computer-only reporting requirement that in theory is to encourage people to better themselves and work.
Only 1,200 people, about 2 percent of those eligible for the requirement, told the state they had done enough of the required activities in August, according to state figures.
The Trump administration Medicaid director thinks this is somehow a great result, though declines to explain her thinking. Advocates for the poor think many don’t know about the rule or how to report. The state insists it’s made enormous efforts to reach people.
But it seems that not everyone opened or read their mail. Ray Hanley, the president of the Arkansas Foundation for Medical Care, which ran a call center for the state, told my colleague Robert Pear that many people never answered their phones. The state said the open rate on emails was between 20 and 30 percent.
It’s harder to measure how many people opened paper mail, but the state noted in its recent report that it knows that thousands of people in the program either move away from their recorded address or fail to answer other mail from the state. Housing instability and moves are more common among low-income Americans.
Jessica Greene, a professor of health policy at Baruch College in New York, visited three Arkansas counties last month and interviewed 18 Medicaid beneficiaries. Twelve of them were unaware of the work requirement, according to an article she published on the website of the journal Health Affairs.
That may not be entirely surprising. “I ignore mailings and calls from my health insurer — I get them all the time,” said Eliot Fishman, a senior director of health policy at Families USA, a consumer advocacy group.But it seems that not everyone opened or read their mail. Ray Hanley, the president of the Arkansas Foundation for Medical Care, which ran a call center for the state, told my colleague Robert Pear that many people never answered their phones. The state said the open rate on emails was between 20 and 30 percent.
Other efforts have been made — and failed — to get changes in behavior through health coverage, such as encouraging preventive health measures. Some people don’t fully read about their coverage. Also, it takes more spending to get the word out, something Arkansas has been unwilling to do.
The article mentions the low rate of computer access in the state and the confusing website for those who can access it. The article invites readers to click the website and try it for themselves. State efforts might ease the problem, the article says.
But evidence from a range of social programs — including Medicaid — has repeatedly demonstrated that administrative hurdles can cause eligible people to lose benefits.
As the program is expanded to more people, awareness and compliance may spread over time. But the early results could mean the end of the program before we know for sure. A lawsuit challenging the work requirement will be reviewed soon by a federal judge who already knocked down a similar work rule in Kentucky. In that case, the judge, James Boasberg, said Kentucky had been insufficiently concerned about the people who might lose coverage because of the requirement. In Kentucky, those losses were theoretical. In Arkansas, they’re already real.
Missing from the analysis is another fact: Lots of people being cut off ARE working, sometimes intermittently through no fault of their own.