Michael Hibblen / KUAR
Grisel Sustache Flores is attending a dispensary in Springdale, Arkansas for low-income patients. Born in Puerto Rico, 46, she learned last fall that she had been eligible for Medicaid, with Arkansas having expanded under the Affordable Care Act to cover more adults . It would only cost him $ 13 a month, so Flores, who suffers from multiple sclerosis, subscribed enthusiastically.
"My doctors in Puerto Rico say that my condition is very difficult," says Flores through an interpreter at the community clinic's health center. "Every day it gets more and more difficult."
She holds out both hands. "Today, my fingers are swollen and numb," she says. "Some days it's hard to stay up for long periods."
But in Arkansas, as in a handful of other states, Medicaid coverage is now subject to conditions for some beneficiaries. The Trump administration has allowed states to enforce what is called a work requirement. In Arkansas, this means that Flores has to work, volunteer or go to school at least 80 hours a month and periodically file reports on the progress made to prove it.
"Recently, they took me out of school because I did not report my hours of work," she says.
Flores said the loss of her Medicaid health coverage was devastating because she needed medication and a physical therapy to control her illness. "I cried, I cried a lot," she says.
The community clinic serves 37,000 low-income patients in the northwest of the state. Irvin Martinez, a specialist in health insurance registrations, said he witnessed a great stir in patients trying to comply with the new Medicaid rules. In Arkansas, the program calls Arkansas Works.
With the help of his keyboard, Martinez opens the Arkansas Works web portal and clicks on arrow icons. "In fact, when I connected to the website with them, I found that they were stuck in their accounts if they were seizing bad data," he says.
Patients who are locked out are invited to call a hotline to help them complete their papers.
"But it's also a problem," says Martinez. "I had a patient call and he received the number in a jail and then in a private house.It took him three calls to the call center to access his account."
Courtesy of Lea Ann Thomas / Community Clinic
In August 2018, a month after the entry into force of the obligation to report the work, the state's Department of Human Services reported that there were 265,223 enrollees Arkansas Works, of which more than 62,000 were subject to the new rule. By December, more than 18,000 people had been unsubscribed from their Medicaid insurance because they did not meet the requirement.
In response, DHS said it had beefed up its call center and made efforts to locate beneficiaries who may have lost their insurance – by phone, email and home visits. The department also launched an awareness campaign with paid advertising on public transit systems across the state and in college newspapers Reminding people that they must comply with the working rule.
The Ministry offers a "bona fide exemption" to beneficiaries who face unforeseen circumstances that make it difficult to meet work requirements. But Martinez said private insurance companies and local non-profit organizations in Arkansas Works have been forced to mobilize to help confused patients navigate registration and reporting.
"Before the Affordable Care Act, almost half of our patients were uninsured," said Kathy Grisham, executive director of the community clinic. "Many have used local emergency rooms for free health care."
More people were assured when Arkansas extended Medicaid. But Grisham says this new work requirement puts a heavy burden on patients – and the providers who serve them.
"People panic when they discover that they are cut off," she says. "We are transferring them to our uninsured population because we have to take care of them."
Robin Rudowitz, associate director of the Kaiser Family Foundation's program on Medicaid and the uninsured, says that a few other states have also been approved by the Trump administration to test Medicaid's extensive work rules, but that these experiments cost money.
"We know that Kentucky has made initial estimates of $ 375 million to implement their two-year waiver," she said.
Arkansas spent $ 7.5 million in start-up costs, according to the Department of Human Services.
But Governor Asa Hutchinson, who launched Arkansas Works, says the program is a success. "We have already had more than 7,000 participants in Arkansas Works who have gone to work," he said.
Arkansas Works' unregistered people have not complied with this rule, according to the governor, who says the working rule instills the responsibility of some Medicaid beneficiaries who need a boost.
"We're just saying that if you're fit and able to work, and you do not have dependent children at home," he says, "you should either work or go to school." School, where you should be volunteering or contributing. "
According to Hutchinson, the number of cases closed in Medicaid is often the result of a turnover: people are moving away, earning too much money to qualify for or taking out Medicare elsewhere.
"There is no increase in unpaid care," he says. "There are not many people coming back and re-enrolling this year, so I think we see that the system removes people who are not eligible for service."
KFF 's Rudowitz organized anonymous focus groups on registrants and indicated that they had indicated that they had followed a difficult learning curve in accordance with the rules.
"The rules are complicated and involve many steps to comply, and many of those who were trying to comply were having problems such as creating these online accounts or browsing the monthly reports. not to find a computer or misuse a computer. "
In Springdale, Flores was able to re-enroll in Medicaid with Martinez's help at the community clinic. She takes out her new insurance papers from her briefcase.
"My new documents have arrived," she says, "and I'm learning how it works."
But Flores says she's now seeking advice to help her deal with the stress of complying with her new health insurance.
Legal Aid of Arkansas, acting on behalf of nine Arkansas Works patients, has filed a lawsuit against the federal government over the regulations. The prosecution argues that the requirements are too burdensome and cause harm to the recipients.