More than 4,500 Arkansas Works enrollees lost their health coverage Saturday for failing to comply with the program's work requirement for three months, according to information from the state Department of Human Services.

Those enrollees had until 9 p.m. Wednesday to visit a state website to report their work hours or an exemption for August to restore their coverage or be locked out of the program for the rest of the year.

But the Human Services Department announced late Wednesday that it would extend that deadline by one month for enrollees whose access to the website, access.arkansas.gov, was hampered by a computer problem that it said affected several state agencies.

The enrollees can submit a request for a "good cause exemption" to the Human Services Department at a county office or by emailing the request to AWgoodcauserequest@dhs.arkansas.gov, department spokesman Amy Webb said in an email.

The request must be submitted by the close of business Oct. 5 and should contain the information on the work hours or exemption for August that the enrollee had attempted to report, Webb said.

Those who lost coverage were the first to face the penalty for failure to comply with the requirement to spend 80 hours a month on work or other approved activities.

Out of about 26,000 enrollees who became subject to the requirement in June, 4,574 had not met the requirement for June, July or August as of Monday, Webb said.

More Arkansans are expected to lose their coverage for noncompliance as the requirement is phased in this year for enrollees age 30-49 and next year for those age 19-29.

Enrollees who fail to comply with the requirement for three months during a year have their coverage terminated and are locked out of the program for the rest of the year.

When it is fully implemented, the work requirement is expected to apply to more than half of the 265,000 people on Arkansas Works, as the expanded part of the state's Medicaid program is known.

For enrollees who lose coverage due to noncompliance this year, the next opportunity to sign up will be Nov. 1. Coverage will start Jan. 1.

In interviews with 18 Medicaid recipients in northeast Arkansas in mid-August, Jessica Greene, a health policy professor at the City University of New York's Baruch College, reported finding a "profound lack of awareness" about the requirement.

In a blog post on the Health Affairs website on Wednesday, Greene wrote that two-thirds of the recipients had not heard about the requirement and that a third said they would not be able to access the state website due to a lack of computer skills or Internet access.

"Clearly, there has not been adequate communication about the policy to those who are being affected by it," Greene wrote.

In a statement, Gov. Asa Hutchinson said the Human Services Department made "every effort to assure compliance," including through letters, emails and phone calls to enrollees, a social media campaign and "hours-long television appearances with the sole focus of notifying and educating current enrollees."

He said some enrollees found other coverage or moved out of state without notifying the department, while others "simply chose not to comply."

"Personal responsibility is important," Hutchinson said. "We will continue to do everything we can to ensure those who qualify for the program keep their coverage, but we will also make sure those who no longer qualify are removed. Otherwise, the taxpayers would be paying for health insurance premiums for those that are not eligible."

David Wroten, executive vice president of the Arkansas Medical Society, said the rate of noncompliance is "a little concerning."

The Human Services Department should try to talk to enrollees whose coverage was terminated and explore whether the program or the department's outreach strategy should be adjusted, he said.

"There's no reason whatsoever for any able-bodied person to not be able to comply with the work requirement," Wroten said. "If they're just ignoring it, I can't say much to help them."

Arkansas in June became the first and so far only state to implement a work requirement for some of its Medicaid recipients. It is also the only state that has been approved to lock enrollees out of coverage for noncompliance for up to nine months.

In Indiana and New Hampshire, which have received federal approval to implement work requirements next year, enrollees who lose their coverage for failing to comply will be able to restore it by coming back into compliance.

A federal judge in Washington, D.C., blocked a similar requirement in Kentucky from taking effect in July.

Two of the groups that filed the lawsuit over Kentucky's requirement have filed a suit in the same court to stop Arkansas' requirement, arguing that President Donald Trump's administration exceeded its authority when it approved the measure.

While Arkansas Works covers people with incomes of up to 138 percent of the poverty level, the work requirement applies only to those with incomes below the poverty level.

For that reason, those who are locked out of coverage in Arkansas won't qualify for subsidized coverage available through healthcare.gov unless their incomes increase.

That assistance is available only to people with incomes of 100-400 percent of the federal poverty level.

Most Arkansas Works enrollees receive the coverage through private plans, with the Medicaid program paying the premium.

Marquita Little, health policy director for Arkansas Advocates for Children and Families, said many people whose coverage was terminated were likely working or qualified for an exemption, but didn't visit the state website because they didn't know about the requirement or lacked access to a computer or the Internet.

Terminating their coverage will make it harder for people with chronic health issues to visit the doctor and fill prescriptions, she said. If their health worsens, she said, they may have more difficulty working.

"We know that a lot of people are going to fall through the cracks and a lot of people who actually need it will end up being the victims of this particular policy," she said.

Bo Ryall, chief executive of the Arkansas Hospital Association, said hospitals have already reported seeing an increase in patients who lack insurance as the state has terminated coverage for Medicaid enrollees who failed to report address changes to the state.

The work requirement will likely have a similar effect, he said.

"When thousands of people lose their health insurance, it's going to increase uncompensated care for hospitals who will be providing care and will not get reimbursed for that care in some instances," he said.

Joe Thompson, director of the Arkansas Center for Health Improvement, said the effect on the state's health care system will depend on why people aren't complying. Some may have moved out of the state or found other coverage, while others may need the Arkansas Works coverage but "have not navigated the process" to comply.

"I think over time we'll have to see which is the more consistent pattern," he said.

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A Section on 09/06/2018