Arkansas DHS to step up outreach on Medicaid work requirement and allow reporting by phone | Arkansas Blog

Wednesday, December 12, 2018

Arkansas DHS to step up outreach on Medicaid work requirement and allow reporting by phone

Posted By on Wed, Dec 12, 2018 at 1:30 PM

STATE TWEAKS REPORTING REQUIREMENT: Governor Asa Hutchinson and DHS Director Cindy Gillespie (file photo). - BRIAN CHILSON
  • BRIAN CHILSON
  • STATE TWEAKS REPORTING REQUIREMENT: Governor Asa Hutchinson and DHS Director Cindy Gillespie (file photo).

The state Department of Human Services announced Wednesday it will begin allowing beneficiaries of Arkansas Works (the state's version of Medicaid expansion, which covers low-income adults) to report their requisite work hours directly to the agency by calling a new "helpline" as of Dec. 19.

The helpline can be reached at 1-855-372-1084 and will operate from 7 a.m. to 9 p.m., seven days a week. DHS will also begin buying paid advertising statewide to inform beneficiaries about the policy, the department's press release said.

In a phone call, DHS spokeswoman Marci Manley said the agency doesn't expect to spend any new money on the new outreach efforts or helpline. "Additional staff and funding won’t be necessary to expand the calling options at this time," she said.

Over 12,000 people have lost coverage since Arkansas instituted the first-of-its-kind work rule in June. Several thousand more likely lost coverage on Dec. 1, though the state has not yet released those numbers.

Until now, the state has required people who are subject to the work requirement to report their hours through a DHS website, http://access.arkansas.gov, or else seek the assistance of a third-party "registered reporter," such as an insurance agent, to help report their information to DHS. Some beneficiaries have said the website is confusing and difficult to use. (It is offline every day from 9 p.m. to 7 a.m., Manley confirmed today.)

Many low-income Arkansans don't have regular internet access. Arkansas households have among the lowest rates of broadband connectivity in the nation, according to U.S. Census data. That's raised concerns that many of the thousands who lost coverage did so because they had trouble with the process for reporting hours, rather than not having a job.

The online-only reporting process has drawn criticism from health advocates, including a federal agency tasked with analyzing Medicaid in the states. Cindy Gillespie, the director of DHS, told reporters in March that the online-only requirement would help push beneficiaries to develop computer skills. She also said at the time that it would save the agency money. "If you implement it in the old-fashioned way of ‘Come into our county office,’ we would have to hire so many people — and that just doesn’t make sense," she said at the time.

Today's press release from DHS included a statement by Gillispie. "We are six months into this new Medicaid demonstration program, but wanted [to] take the time now to access what areas we need to shore up or improve. ... Though enrollees have had the ability to report by phone through carriers, friends, and registered reporters, we felt it was important to expand that option before we roll the next group into the work and community engagement requirement," she said.

Though Arkansas is the only state with a functioning work requirement, several other states' proposals for similar rules have been given the go-ahead from the Trump administration's Center on Medicare and Medicaid Services (CMS). A work rule in Kentucky is mired in a lawsuit, and a federal court challenge to Arkansas's requirement may draw a ruling in early 2019.

That means Trump administration officials are watching Arkansas's experiment closely. On Nov. 27, CMS Administrator Seema Verma defended the state's policy when she was asked by reporters about the recent coverage losses fueled by the work rule. However, she also drew a distinction between work requirements in general and their implementation in Arkansas.

It was important "to separate what’s going on in Arkansas, the policy, from the operations," she told a reporter. Verma also indicated the state might make changes in the near future. "I think you’re going to be hearing a lot more from Arkansas on their plans and what they’re going to do to strengthen the program," she said.

Asked whether the changes DHS announced today were prompted by concerns from Verma and other federal officials, Manley said that the state agency keeps in regular touch with CMS. However, she said, "I think this was more the result of internal review of our operations and the outreach we’ve done." DHS has been evaluating feedback from enrollees, advocates, community organizations and others, she said, and has been re-evaluating its operations as it goes.

"We’ve done a number of things in response to feedback we’ve received," she said.

Governor Hutchinson has dismissed concerns about the online-only reporting requirement. The 12,000 people who lost coverage due to noncompliance with the work rule likely did so because they found insurance coverage elsewhere (such as with an employer), moved out of state or simply don't want to be a part of the workforce, he said earlier this fall. Asked today whether the DHS change indicates other problems might explain the coverage losses, spokesman J.R. Davis said in an email that the governor stood by his comments.

"This is simply providing even more reporting avenues to those on the program ahead of 2019 when the lower age group become subject to the work requirement," he wrote.

Arkansas's work requirement is being rolled out in phases. In 2018, only beneficiaries in the 30-49 age range were subject to the rule. In 2019, those in the 19-29 year range will have to report. Those 50 and older will not be subject to the rule.

The majority of those in the 19-49 group are also exempt for various reasons. To meet the requirement, people must report at least 80 hours per month of work or other "community engagement" activities, including school, volunteering and some job search activities. If a beneficiary subject to the requirement doesn't report 80 hours a month for any three months, he or she is disenrolled from Arkansas Works and barred from signing up again until January of the following year.

Manley said DHS is still developing the budget for its paid advertising effort. "The plan is to use a mix of traditional and online advertising. … So that could involve buses in areas across the state, radio, TV, and it will be directed toward people knowing their options for reporting and know how to report."

Asked whether the state should have committed those resources to advertising and outreach when the requirement was first implemented, Manley said that DHS "leveraged the opportunities that we had for outreach" at the time.

"It’s been an unprecedented outreach that DHS has done," she said.

Though the new DHS helpline will allow beneficiaries to report their hours without having an internet connection, they will still have to have an email address, Manley confirmed. That's because an account must still be created for the beneficiary within the Access Arkansas portal, which requires an email address as a username.

"The information still has to be entered into the portal, but the person would be entering that information … would be DHS staff," she said. "[They'll] also be serving as counselors in terms of offering assistance for the people calling in," Manley said, much as a DHS worker would help a beneficiary visiting one of the agency's county offices in person.

The DHS press release says that "staff working the helpline will start proactively reaching out to individuals who have logged some – but not enough – work and community engagement activities to meet the 80 hours a month requirement. Staff will encourage those enrollees to continue to report their hours and refer them to helpful services."

However, the state's most recent monthly report indicates that only a very small percentage of beneficiaries fit into that category. Out of the 12,128 who did not meet the work requirement in October, only 162 reported an insufficient number of hours. The rest, 11,966, reported no hours whatsoever. That means only about 1.3 percent of those who were deemed noncompliant in October reported more than zero but fewer than 80 hours.

click to enlarge screen_shot_2018-12-12_at_2.23.46_pm.png

Update: The Democratic Party of Arkansas criticized the governor in a statement from Chair Michael John Gray:
“Arkansas's healthcare system ought to be about making sure that people who need to go to the doctor can go to the doctor to get care. The decision by DHS is a step in the right direction. I would say to the governor, 'keep going.' It doesn't go far enough in making sure that people who are eligible for Medicaid aren't getting kicked off arbitrarily. The governor needs to do more so people aren't losing their health insurance because of a self-imposed, bureaucratic work requirement. Without improvement our rural hospitals will suffer, our economy will take a dramatic hit, and tens of thousands of hard working Arkansans could lose their health insurance."
This reporting is made possible in part by a yearlong fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.

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