Arkansas' Medicaid work requirement: Did it work?

When the ACA opened the door for states to expand Medicaid, many sought to tie the expansion to a work requirement. Arkansas was one of the first states to do so in 2018, though a judge eventually blocked the requirement. Still, the short experiment with Medicaid work requirements offers up a glimpse of how effective such programs could be. Unfortunately, the results aren’t promising: Imposing work requirements on Medicaid recipients did not boost their rate of employment, despite the stated aims made by supporters of the programs, according to a recent study from Harvard researchers.

The study, published in Health Affairs this month, assessed a work requirements provision introduced into the Medicaid program in Arkansas in 2018. Researchers at Harvard University conducted a telephonic survey of 2,706 low-income residents in Arkansas, from Nov. 6 to Jan. 3, which built on prior data in 2016 and 2018 about work requirements in Medicaid coverage.

Related: GAO hits Trump administration on costs of Medicaid work requirements

The conclusion: “We found no evidence that low-income adults had increased their employment or other community engagement activities either in the first year when the policy was still in effect or in the longer term, after the policy was blocked.”

More than 18,000 residents of Arkansas lost Medicaid coverage during the year of the program, according to the Harvard study. About 63.7% of respondents in the survey had Medicaid in 2018, down from 70.5% in 2016, but rose to 66.1% in 2019.

Of those who had lost Medicaid coverage, 50% had increased problems paying off medical debt, 56% delayed medical care and 64% delayed taking medications. And the study found no significant differences in employment.

The survey also found significant communication gaps: more than 70% of those surveyed were unsure whether the policy was even in effect.

“Increasing awareness about the program is really important, especially now that the policy is no longer in place,” Chen said. “We worry about people not enrolling in Medicaid because they don’t know what’s going on.”

Another factor that the authors pointed out: the administrative cost of a work-requirement policy, which the researchers pegged at t $26.1 million.

Arkansas is one of at least 10 states that imposed requirements that residents work or do community work to continue to receive Medicaid. President Donald Trump has backed the idea, but lawsuits have challenged the programs, which the Department of Health and Human Services’ Centers for Medicare and Medicaid Services must approve.

“The proponents were arguing that this would be a way to both improve health as well as increase employment among Medicaid beneficiaries,” said Lucy Chen, co-author of the study. “Based on our study, we find that that didn’t happen.”

Read more: 

• Federal judge rules against Medicaid work requirements in Arkansas, Kentucky
• Work requirements in other states advance despite Kentucky Medicaid ruling
• Indiana gets federal approval for Medicaid work requirement, lockout