Working hard, or hardly working? That’s what Arkansas lawmakers want to ask Medicaid enrollees—again.
In June 2018, the state instituted a work requirement for Medicaid (which included coverage for 954,997 people). The idea was to make beneficiaries prove they had a job in order to get federal assistance unless they couldn’t work, were pregnant, or had a disability.
By March 2019, a federal judge blocked and effectively ended the requirement, but 18,000+ Medicaid members had already lost coverage, NPR reported. As of August 2024, nonprofit health policy research organization KFF said about 780,000 people were enrolled in Medicaid in Arkansas.
Arkansas is currently trying to implement another work requirement for Medicaid (with looser reporting requirements), even as the federal government works on a budget that could gut the program and Republican leaders reportedly consider national work requirements.
A new study by think tank the Urban Institute found Arkansas’s program didn’t raise employment numbers as intended—but it did lead to people losing insurance.
The study
Arkansas’s program applied to adults ages 30–49 and required them to file a monthly report on their employment status (at least 80 hours per month) to keep coverage. Recipients were notified of these policy changes via mail, and if they didn’t respond in three months, they risked losing coverage, according to another study conducted by the Harvard T.H. Chan School of Public Health, which also reported similar findings as Urban Institute for changes in employment and uninsurance rates.
To study the effectiveness of the program, Urban Institute researchers pulled Census data and compared coverage and employment trends in that age group, specifically looking at people who earn low and moderate incomes and do not have dependent children, both before and after the program was implemented.
The researchers found Arkansas’s uninsurance rate was similar to other states before the program’s implementation, but after, uninsurance rose in that age group (22.6% to 29.9% from 2016 to 2019). They found “no change” in employer-sponsored insurance, and other age groups’ uninsurance rates also remained the same.
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Meanwhile, the researchers found “no statistically significant change in employment in Arkansas compared to other states,” Michael Karpman, principal research associate in the health policy division at the Urban Institute and an author on the study, told Healthcare Brew.
“The effect was negative, but statistically not significant,” he added.
Why it matters
While the program didn’t last long, it did provide data for experts to determine the work requirement’s effectiveness, as Arkansas was the first state to implement one for Medicaid. Georgia is the only other state to issue a work requirement, though 13 states were approved to make their own rules under President Donald Trump’s first administration.
However, about 9 in 10 people on Medicaid are already working, in school, caring for a child, or unable to work, according to nonprofit Robert Wood Johnson Foundation, which funded the study in an ongoing research effort.
“There’s just not a lot of room to increase employment among the population that’s already working or has faced different barriers to work,” Karpman said.
The other challenge is—unsurprisingly—the bureaucracy that comes with these types of programs.
“People tend to lose coverage not because they’re able to work and they choose not to, but instead, because of difficulty navigating the paperwork requirements,” Karpman said. “Many people never learn about the policy.”
A second report from the Urban Institute estimated a national work requirement could leave 4.6 to 5.2 million US residents ages 19 to 55 uninsured. For Arkansas specifically, the report estimated as many as 87,000 patients could lose Medicaid coverage.
Karpman said there’s “a wealth of research” that shows health insurance improves access to healthcare, reduces medical debt, and helps hospital finances.
“So the loss of Medicaid under work requirements would be expected to have the reverse effect,” he said.