In January 2018, CMS issued new guidance allowing states to impose work requirements as a condition of Medicaid eligibility through the use of Section 1115 Medicaid demonstration waivers. These waivers allow states to test new approaches in Medicaid that differ from federal rules. As of August 8th, 2018, CMS has approved waivers instituting work requirements in Arkansas, New Hampshire, and Indiana, and seven states – Arizona, Kansas, Maine, Mississippi, Ohio, Utah, and Wisconsin – have pending work requirement waivers before CMS. Of note, CMS approved Kentucky’s work requirement waiver in January, but it was voided by a federal judge in June. The court ruled that officials did not adequately consider how the program would impact the ability of citizens to access medical care. CMS is currently seeking public comment on the waiver.

Since the invalidation of Kentucky’s waiver, Arkansas has become the first state to implement work requirements for Medicaid eligibility. Now, all able-bodied Arkansas adults between the ages of 30 and 49 on Medicaid must work, study, or volunteer 80 or more hours each month, or they will lose their health insurance in three months. The requirement will expand to those age 19 to 29 next year. The Arkansas Works Program, which oversees the work and reporting requirements, recently released its July 2018 report which found that just over 46,000 Medicaid enrollees were subject to the requirement in July. Of these, 30,228 were exempt from reporting because they were already employed or in school, had met the work requirement for SNAP eligibility, were disabled, or had at least one dependent child. 12,722 people did not satisfy the reporting requirement, 1,571 reported an exemption, and 844 satisfied the reporting requirements.

Though the majority of people subject to Arkansas’ Medicaid work requirement are meeting it or are legally exempt, some feel that the program overly restricts health care access for low-income individuals, and that those failing to meet the requirements in July may have been unaware of the new rules or lacked necessary internet access. Three consumer groups are suing the Trump administration in an effort to halt the program’s implementation, following on the heels of the successful stoppage of the waiver in Kentucky. The National Health Law program, Legal Aid of Arkansas, and the Southern Poverty Law Center filed suit in the U.S. District Court in D.C. on August 14th, charging that the Arkansas waiver runs counter to Medicaid’s objective of providing health care access to low income individuals.