In Arkansas, residents on Medicaid need to report 80-hours-a-month of work or service online to keep their health insurance under new requirements. So far, more than 5,000 people have failed to do so, jeopardizing their continuous coverage.

About 5,426 people who qualify for the public health insurance program designed for low-income people failed to report 80 hours of work in June and July, according to the latest numbers from Arkansas’ Department of Human Services. If they fail to report hours in August, Arkansas officials will boot people who are otherwise eligible for Medicaid off the program for the rest of the calendar year.

In July, only 844 residents actually satisfied the work requirement, which must be reported online. Nearly 13,000 failed to in July. Of the roughly 43,000 residents subject to the work requirement — a number expected to grow as state officials are rolling out the requirements by age group — the majority were exempt from the requirement.

Federal officials say the requirement is “about giving people an opportunity to work,” but the data doesn’t demonstrate this so far. In fact, state data appears to confirm that most people on Medicaid are working or are too frail to work, as other analyses have also demonstrated. Of the 844 people who have satisfied the rule, it’s not clear who was and who was not already working prior to the policy change. Others could be volunteering to satisfy the requirement.


The Trump administration permitted state lawmakers to condition Medicaid eligibility on work in March. And in June, Arkansas became the first state nationwide to implement Medicaid work requirements. Federal officials have also given Kentucky, Indiana, and New Hampshire the green-light, but a federal judge temporarily blocked Kentucky’s work requirements in June.

Credit: Arkansas Department of Human Services

There’s a chance a federal judge might block Arkansas’ work requirements too. On Tuesday, three Medicaid enrollees with pre-existing conditions (represented by National Health Law Program, Legal Aid of Arkansas, and Southern Poverty Law Center) sued the Trump administration for approving Arkansas’ work requirement and eliminating retroactive coverage. A victory for them could temporarily block further implementation, saving the insurance of the roughly 5,000 residents poised to lose it in September.

The federal judge who struck down Kentucky’s Medicaid work requirement in June called the restrictions “arbitrary and capricious” and concluded that officials didn’t think about people’s loss of health care coverage. Arkansas plaintiffs might be better positioned in court as the state data demonstrates potential coverage loss.

The state data also has health experts further speculating the intent of Arkansas’ work requirement. Joan Alker, a Georgetown University public-policy professor who follows Medicaid closely, asked on Twitter, “Failing system or intended consequence?”


More than 60,000 people were dropped from the Medicaid rolls in the last 18 months, beginning before the work requirement went into effect. State officials point to the strong economy and an improved effort to remove ineligible people. Arkansas Times’ Benjamin Hardy has a good analysis noting that this explanation isn’t enough to explain why Arkansas is losing Medicaid beneficiaries more rapidly than other states that expanded the health care program.