Good story from the D-G’s Andy Davis on a court filing by the Trump administration yesterday, which blamed the state’s ill-conceived requirement that Medicaid beneficiaries report their work activities only via a glitchy website for the massive loss of coverage that followed.
U.S. District Judge James E. Boasberg last month halted Governor’s Hutchinson’s so-called “work requirements” program, which demanded that certain Medicaid beneficiaries fill out paperwork on a monthly basis or have their health insurance taken away.
The Trump administration, which approved the waiver of Medicaid rules to allow the program, the first of its kind in the nation, is appealing Boasberg’s decision. Boasberg found that federal officials failed to engage with the risk of significant coverage losses if the program was allowed. That’s precisely what happened: More than 18,000 Arkansans were stripped of their health insurance.
Attorneys for the Department of Justice, on behalf of the Trump administration, have requested an expedited consideration of the appeal. In a filing yesterday advocating for expedition, the government argued that the state’s rules and infrastructure for implementing the program caused the wave of of coverage losses, and that the issue has now been corrected: The “coverage losses were due in large part to the fact that participants could report compliance through an online portal only, a problem that Arkansas addressed by expanding the reporting options to allow reporting by phone and in person.” (This mirrors previous comments by Trump administration officials that have attempted to put some distance between the Medicaid work requirement policy itself and its troubled implementation in practice in Arkansas.)
The plaintiffs strongly dispute that Arkansas has sufficiently “addressed” the problem, but the acknowledgment from the Trump administration that the state’s rollout was a failure serves as a sharp rebuke to state officials who had initially defended the online-only requirement.
The web portal was widely reported to be glitchy, confusing, and difficult to use. It was offline every day from 9 p.m. to 7 a.m. The Arkansas Nonprofit News Network and others have reported on people who sought help from the state’s Department of Human Services, only to be flummoxed by a bureaucratic trainwreck. Beneficiaries could also seek the assistance of a third-party “registered reporter,” such as an insurance agent, to help them navigate and comply with the electronic reporting requirement, but the state’s education and outreach efforts for this workaround proved inadequate and it was scantly used. (The program’s defenders often pointed to such convoluted workarounds to dispute that the reporting requirement was “online only,” but the Trump administration filing admits the obvious — in practice, that’s just what it was.)
Last year, the Hutchinson administration strongly defended the web-portal-only requirement as it implemented the governor’s red-tape special. When the first wave of Arkansans were kicked off of their insurance last fall, Hutchinson dismissed concerns about the web portal and said that the thousands who lost coverage likely either obtained new insurance from a job, moved out of state, or “simply don’t want to part of the workforce. They’re able-bodied but…they don’t desire to do it.” Hutchinson also tried to fudge the numbers to argue that most people were complying; in fact, only a tiny fraction of those subject to the reporting requirements were doing so (whether they were working or not).
DHS Director Cindy Gillespie, meanwhile, told reporters last year that the web-only requirement would help beneficiaries develop computer skills. “Having that little bit of computer…literacy is important if you are going to be able to be moving up the income ladder,” she said. Only the state invested zero resources in teaching computer literacy skills. They just took people’s health insurance away if they didn’t have those skills, didn’t have internet access at all, or didn’t manage to successfully navigate the confusing new bureaucracy created by DHS.
Perhaps more to the point, Gillespie also noted that the requirement would save the agency money. “If you implement it in the old-fashioned way of ‘Come into our county office,’ we would have to hire so many people — and that just doesn’t make sense,” she said. Indeed, the state put zero additional funding into outreach and education efforts even as it implemented a new requirement impacting the health insurance of tens of thousands of Arkansans, with predictable results.
Amid a flurry of criticism, the Hutchinson administration finally caved and began allowing telephone reporting in December. Even then, Hutchinson stood by his previous comments that the coverage losses were not due to the program’s design. “This is simply providing even more reporting avenues,” the governor’s spokesman said.
The Trump administration now says otherwise, blaming the portal for the program’s troubles. Of course this comes in the context of a tendentious claim that everything is hunky dory now. Critics of the work requirements have noted that the telephone hotline that the state created has problems of its own, and the fundamental issue remains the same: The state is creating confusing bureaucratic hoops for low-income beneficiaries to jump through with no corresponding investment in outreach, which will have the effect of culling the rolls even if beneficiaries are working.
Meanwhile, the Trump administration’s claim that the state addressed the problem by “expand[ing] the reporting options to allow reporting…in person” is not accurate. It’s always been the case that beneficiaries could go to a county office and use a computer kiosk to log in and do the electronic reporting; there has been no policy change on that front. Department of Human Services spokesperson Amy Webb just confirmed as much to me. Webb said that staffers at county offices can assist beneficiaries who use these kiosks, but Legal Aid of Arkansas, among those representing the plaintiffs, say that this assistance is limited and inadequate.
From the D-G report:
Kevin De Liban, an attorney with Legal Aid of Arkansas, said it’s “factually and demonstrably false” that Arkansas added an option for enrollees to report in person on their compliance with the requirement.
Enrollees could access the website, access.arkansas.gov, at a Department of Human Services office, but they didn’t receive any help creating an account on the site or reporting their hours or exemption status, said De Liban, whose Jonesboro-based organization is one of three advocacy groups that challenged Arkansas’ requirement in court on behalf of several enrollees.
“What somebody would do is sit you down and turn the kiosk on, or help you get on the kiosk, and get you to access.arkansas.gov, and that’s it,” he said.
The phone reporting option, which often involved spending 45 minutes to an hour on hold and being transferred to multiple people, didn’t improve compliance, he said.
In January and February, about 5 percent of the enrollees who were required to report hours of work or other activities did so, down from about 9 percent in December and 6 percent in November.
One rather astonishing argument the Trump administration made in its filing for expedited consideration of its appeal: “The experience with the rollout of the Arkansas project only underscores the value of testing experiments at the local level before policies are established nationwide.”
It’s worth stepping back here. Arkansas applied to implement a controversial work requirement and the Trump administration gave the green light with scant consideration for the potential of dramatic coverage losses. This despite no compelling connection to the purpose of the Medicaid program, and no evidence that the governor’s busybody requirement would actually help more people become employed, its ostensible purpose. From the beginning, the state showed scant interest in evaluating how effective the program would be at meeting that purported goal, or what the consequences might be for access to care for low-income citizens.
The state then botched the rollout, as the Trump administration now admits, with precisely the results predicted by the policy’s critics, including those who submitted comments to the Trump administration when Arkansas originally applied for the waiver. Now the Trump administration says that this fiasco is a great example of the value of testing experiments! The only cost of this failed experiment was the loss of health insurance for more than 18,000 poor people.
That’s not all. The Trump administration is eager to roll out the policy “nationwide” — its hope for expedition partly to accelerate the timetable for doing just that — despite admitting that the only test so far led to massive coverage losses. It claims, without evidence, that despite the failure of its initial rollout, Arkansas has solved the problem. But there was no evident uptick in compliance with the reporting requirement after the telephone hotline was introduced, the only policy change the state made. If the Trump administration is arguing that the state’s rollout made it too difficult for beneficiaries to comply with the reporting requirement, Arkansas still has a long way to go.
The implementation of the policy by state officials was incompetent; the oversight by federal officials in approving the waiver was nonexistent. This does not inspire confidence that the problems raised by Boasberg will be addressed.
“Arkansas might use the time while the program is paused to consider whether and how to better educate persons about the requirements and how to satisfy them,” Boasberg wrote in his opinion. I won’t hold my breath. The online-only requirement was not just a ham-fisted unforced error — it speaks to the fact that the state’s true focus in seeking the work requirements program have nothing to do with the Medicaid program’s purpose of providing health coverage. I can’t know what’s in Hutchinson’s heart, but I can tell you that if I personally was to design rules that were meant to give political cover to kick people off of their Medicaid coverage in order to save the state some money, the Arkansas rollout of the program is more or less what I would come up with. If, just for the sake of argument, that was the real goal here, the website requirement was a devious touch.
It should come as no surprise that the implementation of this complex new bureaucracy has been a scandalous failure. The state invested no additional funding into outreach or work support services and has a long history of horrifically poor communication efforts with beneficiaries leading to kicking people off the rolls. The initial web portal requirement was designed to skimp further on costs, which helps clarify where the governor’s priorities were. The priority was not making sure that beneficiaries understood the requirements or had supports in place to succeed in the new program. For all of the rhetoric, the priority was not to help people get to work. The one area where the program has been ruthlessly efficient is removing people — including people who are working — from the Medicaid rolls.