This month, the Arkansas Department of Human Services soft launched new work requirements for the state's Medicaid expansion program. Ozarks at Large's Daniel Caruth has more details.
On July 1, the Arkansas Department of Human Services launched its new welfare to work requirements for adults enrolled in the Arkansas Health and Opportunity for Me (ARHOME) Medicaid program. It's an initiative that Gov. Sarah Huckabee Sanders has been pushing for since taking office. Here she is announcing the work requirement plan at a press conference in 2025.
"220,000 able bodied, working age adults in Arkansas receive free health care, courtesy of the Arkansas taxpayer. It cost us more than $2.2 billion each year and growing. Of those recipients, estimates show that nearly 90,000 have no job."
The new rules require Medicaid and ARHOME recipients ages 19 to 64 to work, volunteer or attend school at least 20 hours per week, though penalties won't begin until Jan. 1. State officials say the phased approach will give Medicaid recipients time to adjust to the reporting system.
The new guidelines are part of a broader federal push mandated under the Trump administration's Big Beautiful Bill Act, signed in 2025 to cut Medicaid costs, and come nearly seven years after a federal judge struck down an Arkansas law instituting such work requirements. Arkansas was the first state in the nation to institute this kind of program.
Laura Harker is a policy researcher for the nonprofit Center on Budget and Policy Priorities and analyzed Arkansas' 2018 program, which she says left 18,000 people uninsured.
"So a lot of people were finding out at the point of their care when they really needed it, and that often left them to be sicker. They were not able to work because they didn't have their prescriptions or they weren't able to get their care. So that essentially left them to lose their job, which means they aren't able to report hours to get their coverage back. So kind of just creates this cycle. Supposed to be encouraging work, but instead it tends to punish folks who are working and really need that health coverage to continue working."
Harker says many Medicaid recipients actually already work, and that implementing these new systems will likely end up costing Arkansas more money.
"States are spending millions of dollars contracting with companies, or having to hire new caseworkers to meet the demand, to answer questions, to try to verify all of these different exemptions or work hours. So it just is a lot of extra bureaucracy for something that is not truly an issue that exists. Most people in Medicaid are working already or have other reasons why they may not be."
She also says coverage losses will have an impact on hospital systems in the state, specifically in rural areas and small towns, where roughly 28% of residents depend on Medicaid for coverage.
Dr. Julie Gralow is chief medical officer and executive vice president of the American Society of Clinical Oncology, and she says these new guidelines increase the burden on some of the most vulnerable populations, like cancer patients.
"Those who meet this frailty exemption for the work requirement are the people who are least able to track and regularly report and get through the processes of all of the administrative burden in order to qualify. And there will be gaps, not because you're not eligible for the exemption, but because you just can't manage the system and get things in on time. And if you've got delays in your coverage that could have real life threatening implications for a patient."
The program allows exemptions for pregnant and postpartum women, former foster children under the age of 26, parents or caregivers of children under 14, veterans with a total disability rating, people enrolled in Medicare and those who can prove medical frailty.
Gralow says petitioning for and maintaining these waivers, though, puts too much burden on those who qualify for coverage and could cost people life saving care.
"Well, what we what we learned from that Arkansas experiment, if you will, is that roughly one in four people who were subject to the work mandate lost their health coverage not because they were no longer eligible for the exemption of the work hours, but because they couldn't navigate the reporting portals and document their medical exemptions in a timely way. One in four during that that prior model, that prior pilot. So I don't know why it would be any different this time. And actually, it looks like the reporting is going to be more frequent and more onerous. So it could be much higher. And that has real life threatening implications for people dealing with a cancer diagnosis."
On July 1, the Arkansas Department of Human Services began an automated process of verifying eligibility and compliance with the new guidelines. The department says recipients will receive a notice detailing whether they meet the upcoming requirements.
Last month, the department launched a new web portal, access.arkansas.gov, to help Medicaid recipients manage their information.
According to numbers from the Centers for Medicare and Medicaid Services, around 710,000 Arkansans, 23% of the state's population, are enrolled in Medicaid as of March, while 210,000 are enrolled in the ARHOME program. Census Bureau data from 2024 shows the number of adults in Arkansas without health insurance is at 9.4%.
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