Medicaid Work Requirements in Arkansas: Two-Year Impacts on Coverage, Employment, and Affordability of Care

Abstract

In June 2018, Arkansas became the first state to implement work requirements in Medicaid, requiring adults ages 30-49 to work 20 hours a week, participate in “community engagement” activities, or qualify for an exemption to maintain coverage. By April 2019, when a federal judge put the policy on hold, 18,000 adults had already lost coverage. We analyze the policy’s effects before and after these events, using a telephone survey in late 2019 of 2,706 low-income adults in Arkansas and three control states, compared to data from 2016 and 2018. We have four main findings. First, most of the Medicaid coverage losses in 2018 were reversed in 2019 after the court order. Second, work requirements did not increase employment over 18 months of follow-up. Third, 30- to 49-year-olds in Arkansas who had lost Medicaid in the prior year experienced adverse consequences – 50 percent reported serious problems paying off medical debt; 56 percent delayed care due to cost; and 64 percent delayed medications due to cost. These rates were significantly higher than among Arkansans who remained in Medicaid all year. Finally, awareness of work requirements remained poor, with more than 70 percent of Arkansans unsure whether the policy was in effect.