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With new work requirement, thousands lose Medicaid coverage in Arkansas

A major initiative of the Trump administration has been adding work requirements to benefit programs for the poor, now including Medicaid. This year, Arkansas became the first state to roll out the requirement. As a result, more than 12,000 people there have lost their coverage. Special correspondent and Washington Post columnist Catherine Rampell travels to Arkansas to explore what’s at stake.

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  • Judy Woodruff:

    One of the Trump administration's major initiatives has been adding work requirements to government benefit programs for the poor. That includes Medicaid for the first time in its history.

    This year, Arkansas became the first state to roll out the requirement. It — so far, it affects a small percentage of those who got Medicaid coverage through the Affordable Care Act. But more than 12,000 people have lost their coverage for not complying, and thousands more are expected to follow suit.

    More than a dozen other states have expressed intention to impose their own requirements.

    Special correspondent and Washington Post columnist Catherine Rampell traveled to Arkansas to explore what's at stake.

    Well, I just got out of the hospital.

  • Catherine Rampell:

    Adrian McGonigal's life is coming undone.

  • Adrian McGonigal:

    They were wanting me to stay longer, but…

  • Catherine Rampell:

    In the past few weeks, he's lost his job, his health insurance, even his feelings of self-worth.

  • Adrian McGonigal:

    Without my medication, I can't really sleep good, so…

  • Catherine Rampell:

    He's worked all his life. But now, at the age of 40, he's entirely dependent on people like his mom to get by. And he blames the U.S. Department of Health and Human Services.

  • Woman:

    Your status as far as?

  • Adrian McGonigal:

    The Arkansas Works is concerned.

  • Catherine Rampell:

    This summer, he had a decent-paying job at a chicken plant outside Bentonville. But when the Trump administration allowed the state of Arkansas to impose new work requirements on Medicaid, he, like many Medicaid recipients, got confused about how to report his hours.

  • Adrian McGonigal:

    I thought that everything was good about this. I thought it was just a one-time deal, that you report it, and then that was it.

  • Catherine Rampell:

    He was wrong. He was supposed to log those hours online every month. He became one of the 12,000 people that the state has booted from the Medicaid rolls in the last three months.

  • Adrian McGonigal:

    How do I get my insurance back on?

  • Catherine Rampell:

    He discovered this only when he went to fill prescriptions at this drug store and the pharmacist told him, sorry, your coverage has been canceled.

  • Adrian McGonigal:

    And that it was going to be like $340 for one of the medications, and like $80 for the other one.

  • Catherine Rampell:

    So, he left empty-handed. This was a big deal, because McGonigal has severe COPD, a chronic lung disease that makes it difficult to breathe.

    Without his meds, he landed in the hospital multiple times and missed a lot of work. His supervisor tried to accommodate him, but he wasn't healthy enough to perform his job. So he lost it.

    He's now part of a lawsuit against the federal government, charging that his story is a cautionary tale. His lawyers say it proves why adding work requirements to a health insurance program can backfire and actually make it harder for the poor to hold down a job.

    Arkansas is the very first state in the country to require people to prove that they're working if they want to receive Medicaid. Now other states are watching to see how the experiment works out.

  • Sarah Sanders:

    The policy will allow states to design programs that help beneficiaries improve health and well-being.

  • Catherine Rampell:

    Since the Trump administration announced Medicaid work requirements would be allowed, five states have gotten approval, though Kentucky's was blocked by a federal judge. Nine other states have also applied.

    Many conservatives say it would make them feel more comfortable with Obamacare's Medicaid expansion for able-bodied adults, which they see as a new entitlement. But they also argue that work requirements will help the poor.

  • Cindy Gillespie:

    There's been a lot of research over the years around the connection between not just work, but work and community engagement, as a health factor.

  • Catherine Rampell:

    Cindy Gillespie is the director of the Arkansas Department of Human Services, which oversees the state's Medicaid program.

  • Cindy Gillespie:

    Anyone who becomes isolated, who is not actively engaged in some way with others, with family, community, with workplace, their health suffers. You see that across the board.

  • Catherine Rampell:

    She says the state has made every effort, including establishing a new call center, to connect with roughly 70,000 people who now need to prove they're working, attending school, or volunteering for at least 80 hours each month.

    Some hours spent job searching can also count. Many are exempted from reporting because the state already knows they work at least 80 hours a month. They're caregivers or are undergoing treatment for addiction, among other exceptions.

    The state invested no additional dollars in helping people find work, but Gillespie says Medicaid enrollees should take advantage of the services that already exist.

  • Cindy Gillespie:

    The goal of the program is to find those individuals who, for one reason or another, life has them at a point where they can't get out of poverty, and it's to actually find them and help them move up the economic ladder.

  • Kevin De Liban:

    I mean, work requirements are not ultimately for the benefit of low-income individuals on Medicaid expansion.

  • Catherine Rampell:

    Kevin De Liban is an attorney with Legal Aid of Arkansas. This nonprofit, along with the Southern Poverty Law Center and the National Health Law Program, is suing to block the Medicaid work requirements.

  • Kevin De Liban:

    They're based on two huge myths. The first is that poor people are lazy. So the fact is, most people are working or have a barrier to work. The second myth is that these work requirements are somehow lending people a hand up.

    That's absolutely false. There's not an extra dime of money invested in meaningful job training or anything that would empower people to get skills that would allow them to qualify for something other than low-wage work.

  • Catherine Rampell:

    The new rules have proven especially worrisome in the many rural parts of Arkansas, like the Ozark Mountain town of Marshall, where jobs are hard to come by.

    Many poor residents in this region rely on Boston Mountain Rural Health Center clinics. Debbie Ackerson is the CEO.

  • Debbie Ackerson:

    Well, it's really difficult, because if the people in this category are required to work, and there are no jobs, then you know, what are these people supposed to do?

    They can — they will lose their insurance, and it's not anything that they can prevent. They can say they have been searching, but there's only so many places that they can apply.

  • Catherine Rampell:

    Those who don't comply for three months are kicked off Medicaid and barred from re-enrolling until the next January.

    Anna Book worries she's hanging onto her health care by a thread. She works about 24 hours a week as a dishwasher at a restaurant in downtown Little Rock. Book has spent many years homeless, getting help from pastor Paul Atkins at Canvas Community Church.

  • Paul Atkins:

    So, you reported income, 51 hours.

  • Anna Book:

    Oh, so I missed about 30 hours?

  • Catherine Rampell:

    He now works with her each month to log her work hours. If she makes every shift at the restaurant, she is just able to meet the monthly threshold.

    But it's not just putting in the hours. Users or their authorized designees then have to record that time in an online-only portal. That portal shuts down every night at 9:00 until 7:00 the next morning. And Arkansas has the lowest household Internet access of any state.

  • Anna Book:

    Being homeless, I don't have a lot of access to anything. I have Paul do the insurance, who actually files the work requirements for me, because I don't have access to a computer to do it.

  • Catherine Rampell:

    Some of the confusion will be resolved with time, Cindy Gillespie says.

  • Cindy Gillespie:

    When anything is new, people do struggle with it. They're confused. They don't know what to do. So, that's why we have tried really hard to set up different ways for people to come back and talk to someone who can help them.

  • Catherine Rampell:

    So, then, what would you — how would you explain the fact that something like 80 or 90 percent of people who are required to report work hours are not reporting work hours? They're just — they're too unmotivated, or…

  • Cindy Gillespie:

    Some are. Some are just not — they don't value the insurance. They're not using it. They don't value it would be part of it. That's what you do hear from some people.

    From others, it may just also be a case they don't know that they're insured and don't really care to be insured, if they received a notice.

  • Catherine Rampell:

    I would find it very surprising that people don't want to be insured if they're — if it's not costing them anything.

  • Cindy Gillespie:

    But it costs them something if they then have to begin to engage in activities, report income they don't want to report, et cetera.

  • Catherine Rampell:

    Back in Bentonville, McGonigal's lawyers have made some progress. They convinced the state to give him a good cause exemption.

    But thanks to additional red tape, he still hasn't been able to get any of his meds. Meanwhile, his hospital bills have piled up. On the day we visited, he opened bills totaling more than $4,000.

  • Adrian McGonigal:

    It's bills in my name that there's just — I don't have any options.

  • Catherine Rampell:

    But even if he can get his meds, and the state covers the backlog of bills, and he gets his job back, his health may be permanently damaged.

  • Adrian McGonigal:

    The doctors told me each time that I have just, like, COPD flare-ups, it gets a little bit worse each time. So, I mean, that damage there is already done.

  • Catherine Rampell:

    He's resting for now, and hoping for the meds that will get him back to better health and back to work.

    For the "PBS NewsHour," I'm Catherine Rampell in Bentonville, Arkansas.

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