Under rules established by Arkansas during the first Trump administration, Medicaid participants must be under 50 years old. had to report They spent at least 80 hours each month working, going to school, training or volunteering. The rule only applied to people who became eligible after Arkansas expanded Medicaid under the ACA to include adults making up to 138% of the federal poverty level.
Also, people who are pregnant, have children under the age of 18 at home, people with disabilities, people who must care for someone who is unable to care for themselves, people who are undergoing alcohol or drug treatment, and people who have full-time care. Those attending school or vocational training at Time were exempt.
Approximately 70,000 About 1 in 4 of the roughly 270,000 Arkansans receiving Medicaid were subject to the new rules, and about 1 in 4 of them lost coverage.
Unlike Arkansas, Georgia has not expanded Medicaid under the Affordable Care Act. But it is The road to reporting Launched in July 2023, the program allows people with household incomes up to 100% of the federal poverty level who are not yet eligible for Medicaid to enroll in the program if they meet work requirements. . Georgia’s qualifying activities and exemptions are similar to those of Arkansas.
Georgia Department of Community Health spokeswoman Fiona Roberts told Stateline that 5,548 people were enrolled in the program as of Nov. 15, with a total of 7,518 enrolled at one point. This program helps people transition from Medicaid to private insurance.
However, in the first year, only Pathways to Coverage was registered. Approximately 4,200 people — far fewer than the 25,000 the state had expected. of Program costs According to KFF, a nonprofit health research group, healthcare spending was $26.6 million at the end of 2023, more than 90% of which went to administrative and consulting costs. If Georgia had chosen full expansion under the ACA, the federal government would have picked up 90% of the tab and the state would have footed the bill. Approximately 359,000 people.
Leah Chang, director of health justice at the Georgia Budget and Policy Institute, said work requirements are especially tough for people living in rural areas.
“If you don’t have broadband internet at home, you won’t be able to upload documents or pay stubs,” Chan told Stateline. “Even those who are eligible cannot keep up, especially in rural areas where there are additional barriers to participation.”
“Learn from your mistakes”
Benjamin Somers, a professor of health economics at Harvard’s T.H. Chan School of Public Health and one of the authors of the Arkansas study, said the experience with work requirements in Arkansas and Georgia should give other states pause. He said it was supposed to be.
“All that ended up happening was that red tape caused people to lose insurance, become uninsured, and in some cases worsen access to health care,” Somers said.
But Rep. Aaron Pilkington, a Republican from Arkansas and a member of the chamber’s health committee, said Medicaid work rules are “100% on the table, and that’s what we want from the Trump administration.” said.
“They can find work through their employer and get better health insurance,” Pilkington said. He said volunteering and education options make the rules even more attractive.
Meanwhile, in some of the 10 states that have not expanded Medicaid under the ACA, including work requirements may be the only political way to get expansion across the finish line.
“Most Democrats I talked to didn’t want a work requirement, but the most likely way to get it through the Mississippi Legislature is to have a work requirement,” said Mississippi Republican Sam Creekmore. the congressman told Stateline.
“We have reviewed Georgia’s plan. We are aware of the pitfalls and will hopefully learn from our mistakes.”
missouri independent‘s Jason Hancock contributed to this story.
state line is part of States Newsroom, a nonprofit news network supported by a coalition of grants and donors as a 501c(3) public charity. Stateline maintains editorial independence. If you have any questions, please contact editor Scott S. Greenberger at [email protected].
