The work requirement for Arkansas' expanded Medicaid program will worsen the health of the state's low-income residents, including those with mental illness; hurt health care providers financially; and increase the state's costs, an advocacy group for the mentally ill contends.

The National Alliance on Mental Illness made the arguments in a friend-of-the-court brief submitted Friday in a federal lawsuit in Washington, D.C., challenging the requirement.

Filed in August by advocacy groups for the poor, the lawsuit argues that President Donald Trump's administration exceeded its authority under the federal laws governing Medicaid when it approved the eligibility condition in March.

More than 12,200 enrollees have lost coverage as a result of Arkansas' work requirement since the state began phasing it in in June. The rule requires enrollees to work 80 hours a month or engage in other approved activities, unless exempted, and to report their status using a state website, access.arkansas.gov.

Enrollees who fail to meet the requirement for three months during a year lose their coverage and are barred from re-enrolling for the rest of the year.

In its brief, the Arlington, Va.-based mental health advocacy group argued that taking health coverage away from enrollees exposes them to the risk of incurring medical bills that could drive them into bankruptcy.

Health care providers will also suffer from being stuck with more unpaid bills, the group argued.

Without coverage, enrollees will put off medical care until their health deteriorates, making them more expensive to care for when they eventually become eligible to re-enroll in the program, the group argued.

"Periodic gaps in coverage trigger a cascade of negative health effects," the group said in the brief. "Even the short-term uninsured are consistently and significantly less healthy than the insured."

Those with mental illness will be especially hard hit, the group contends. People with serious mental illness die about 25 percent earlier on average than the rest of the population, it said.

About 60 percent of the deaths are caused by heart, lung and infectious diseases "that could be identified and treated if the proper screenings were conducted," the group said.

The group also argued that the work requirement won't achieve its aim of increasing enrollment among enrollees. Some have health conditions or obstacles, such as a lack of transportation, that prevent them from working, the group said. Others are already working but may have trouble using the website to report on their compliance, the group argued.

Gov. Asa Hutchinson's office hadn't reviewed the brief on Monday and could not comment on it, spokesman J.R. Davis said.

In an interview on the Talk Business and Politics program Sunday on KATV, Channel 7, the Republican governor said the requirement is "a success story" because 3,800 enrollees have moved "from nonwork into employment and up the economic ladder."

He reiterated his contention that many people who have been terminated from the program were no longer eligible because they had moved out of state or found a higher-paying job but didn't notify the state.

"I've talked to hospitals. I've talked to medical care providers out there, and we're not seeing a jump in uncompensated care, so that tells me that these numbers that are going off are those that have moved out" or found jobs or other sources of coverage, he said.

Reducing the rolls is saving the state money because it no longer has to pay premiums to insurance companies for plans covering the enrollees who lose coverage, he added.

"I worry about those that maybe out of neglect, they didn't send it in or maybe even it was intentional, they just didn't want to bother with it, they wind up in the hospital -- I do worry about that population," he said.

But he noted that the enrollees who were kicked off the program can sign up again to have their coverage start Jan. 1

"They have to exercise their responsibility to do it, but if they go to a health care provider, they'll help them to re-enroll," he said.

The work requirement, the first such condition ever added to a Medicaid program, was phased in this year for enrollees age 30-49 and will start next year for those age 19-30.

It applies to enrollees who were made eligible for Medicaid in 2014 when the state expanded the program to cover adults with incomes of up to 138 percent of the poverty level.

The income cutoff this year, for instance, is $16,753 for an individual or $34,638 for a family of four.

Most enrollees receive the coverage through private plans, with the Medicaid program paying most or all of the premium.

The lawsuit was filed on behalf of three Arkansas Works enrollees by the National Health Law Program, the Southern Poverty Law Center and Jonesboro-based Legal Aid of Arkansas and will be decided by U.S. District Judge James Boasberg, who in June blocked a work requirement from taking effect in Kentucky.

In that case, filed by the National Health Law Program and the Southern Poverty Law Center, Boasberg ruled that U.S. Health and Human Services Secretary Alex Azar didn't adequately consider the effect a work requirement would have on residents' health coverage.

The Arkansas lawsuit was amended earlier this month to add six more plaintiffs, including two who temporarily lost their coverage as a result of the requirement but were able to get it restored after being granted "good cause" exemptions.

A group of 39 health-policy professors and researchers, including the deans or associate deans of six public-health or health-policy schools, submitted a brief in support of the plaintiffs on Nov. 7, saying in part that they agreed that federal law does not allow states to add work requirements to their Medicaid programs.

A Section on 11/20/2018