Under the new special session amendment,
60,000 Arkansans will no longer be eligible for the Arkansas Works program. The bill restricts eligibility to those who make 100 percent or less of the federal poverty level. Previously the program was open to those making 138 perc
ent or less of the federal poverty level.
Additionally, the amendment imposes a work requirement to certain individuals on the Arkansas Works program " to encourage beneficiaries to work and to support beneficiaries in the process of returning to the workforce," the bill states.
Arkansas Works under the Trump Administration: new rules coming in 2018, pending HHS approval
The Arkansas Works waiver allows the state to continue to implement Medicaid expansion using private coverage, and to implement some modifications to the program. But some modifications - like a work requirement and an asset test - were not permitted by CMS under the Obama Administration.
The changes suggested include:
- A work requirement
- Capping eligibility at the poverty level, instead of 138 percent of the poverty level.
- Using Medicaid expansion funds to pay premiums for employer-sponsored health insurance for employees who earn between 75 percent and 100 percent of the poverty level (as opposed to only for employers who are newly offering coverage, as is the case with the current Arkansas Works waiver).
- Allowing state control of eligibility determination, which the state says it can now do with a new computer system it has put in place.
The bills call for Arkansas to seek a waiver from HHS allowing a work requirement for some Medicaid enrollees, and a Medicaid expansion eligibility cap of 100 percent of the poverty level. Assuming HHS approves the lower eligibility limit and the work requirement, they would take effect in January 2018. The legislation also calls for the state to "study and analyze" small employer coverage in Arkansas, and determine ways to strengthen employer-sponsored insurance and help more businesses offer coverage to their workers.
Capping eligibility at the poverty level instead of 138 percent of the poverty level would make 60,000 current Arkansas Works enrollees ineligible for coverage. They would be switched instead to regular premium subsidies (and
if they pick Silver plans) for plans purchased in the exchange. However, their premiums and out-of-pocket medical costs, even after subsidies, would be substantially more than they are with Medicaid, making coverage and health care unaffordable for some of them.
The state is currently paying 5 percent of the cost of covering that population on Arkansas Works, and that will increase to 10 percent in 2020. But if current enrollees with income above the poverty level switch to regular exchange plans instead of Arkansas Works, the state will no longer be paying for any of their coverage. Instead, enrollees will pay some premiums and the federal government will pay the rest, via premium subsidies.