NC Budget and Tax Center

Evidence from Arkansas: Medicaid work requirements don’t work

Last week, Governor Cooper vetoed the General Assembly’s conference budget, pointing to harmful corporate tax cuts, a failure to fully fund the needs of teachers and their classrooms, and a failure to include Medicaid Expansion. Both the Governor and Secretary of Health and Human Services Mandy Cohen have noted that any Medicaid Expansion bill will likely include compromises.

It is highly likely that requirements to report work are being considered as a form of a compromise, but evidence shows that these requirements fundamentally undermine the expressed purpose of Medicaid itself and will result in struggling North Carolinians jumping through hoops to prove that they are working as a condition of receiving medical coverage. A recent report in the New England Journal of Medicine evaluates the impacts of Arkansas’s work requirement provisions. The report finds that:

Work reporting requirements prevented people from accessing health care while doing nothing to boost employment:

  • From 2016 to 2018, the percentage of 30-49-year-olds with ACA marketplace coverage dropped from 70.5 percent to 63.7 percent, much more than groups not subject to work requirements.
  • The percentage of uninsured adults ages 30 to 49 increased from 10.5 percent to 15 percent while other groups remained unchanged – in control states, the uninsured rates were unchanged for this same population.
  • From 2017 to 2018, employment among groups subject to work requirements declined from 42.4 percent to 38.9 percent.

Due to massive amounts of red tape and administrative burdens, many working Arkansans were unjustly denied health insurance:

  • 97 percent of people subject to the requirements were already meeting the work and community engagement requirements prior to the policy taking effect.
  • 9 percent of people subject had not heard anything about the policy change.
  • More than 44 percent of people were unsure about whether the requirements applied to them.
  • 100 percent of people who failed to report because they thought they had not satisfied the requirements had, in fact, satisfied the requirements.

You can read the entire report HERE.

Brian Kennedy II is a Public Policy Analyst for the Budget & Tax Center at the N.C. Justice Center.

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