Medicaid Work Requirements in Arkansas Expose Systemic Failures and Harm Vulnerable Populations

Republican advocates for Medicaid work requirements—policies that could result in permanent cuts affecting up to 14 million beneficiaries—often lack firsthand understanding of the practical challenges involved in complying with such mandates. Drawing from frontline experience as legal aid attorneys assisting low-income Arkansans during the 2018 rollout of these requirements, we witnessed the widespread disruption inflicted on Medicaid recipients, healthcare providers, pharmacies, social service organizations, and state workers alike. No responsible government should knowingly impose such turmoil on its constituents.

Within just five months before judicial intervention halted the program, over 18,160 Arkansans lost their Medicaid coverage, including many of our clients. One such individual, Adrian McGonigal, suffered from chronic obstructive pulmonary disease and was undergoing treatment. Although employed 30 to 40 hours weekly at a poultry processing plant—earning more than in any previous job and ostensibly meeting work criteria—he was unable to navigate the state’s flawed system for verifying employment. Struggling with a complicated monthly reporting requirement, Mr. McGonigal lost his Medicaid benefits, could not afford necessary medications, experienced multiple emergency room visits, and subsequently lost his job. His health deteriorated, and after years of unstable low-wage employment, he passed away in November.

Numerous other working individuals faced comparable obstacles. Our clients included fast-food employees, restaurant dishwashers and servers, construction laborers, janitors, landscapers, motel housekeepers, gas station attendants, and nursing assistants. Many had disabilities requiring ongoing treatment for chronic pain, asthma, injuries, cancer, or mental health conditions. Some lost coverage because they could not manage the complex reporting requirements; others were victims of precarious employment conditions, such as sudden cuts in hours, layoffs, limited transportation options, or living in economically distressed rural areas with few job opportunities. The loss of Medicaid often precipitated health declines and job loss, further undermining their capacity to regain employment.

The upheaval extended to all Medicaid recipients. Despite state outreach efforts, confusion and anxiety were widespread, as many were unsure whether their Medicaid plan was subject to the new work mandates. Recipients received lengthy, often contradictory letters from the Medicaid office, causing further uncertainty. The online reporting system was plagued by nightly shutdowns at 9 p.m. and was so complicated that we produced instructional videos to assist users, though many still struggled. Beneficiaries spent hours on calls or visiting offices to clarify their status or correct errors, frequently requiring legal assistance. Some had to repeatedly request wage verification or statements from employers to meet state criteria. Ultimately, 18,164 individuals were disenrolled due to noncompliance, with thousands more losing coverage because of related administrative burdens.

These penalties also imposed financial strain on critical sectors of the economy. Rural hospitals and clinics, already operating on thin margins, faced increased costs from billing complexities, uncompensated care, and assisting confused patients with eligibility documentation. Local nonprofits—including homeless services, domestic violence shelters, food banks, soup kitchens, and senior centers—diverted limited resources to help affected individuals comply with the requirements. Pharmacists encountered desperate patients who suddenly learned they had lost coverage and faced out-of-pocket prescription costs.

The state Medicaid agency itself was overwhelmed. Management delegated the burdensome tasks of resolving persistent system errors, devising workarounds, and addressing distressed beneficiaries to already overextended caseworkers. At one point, call centers expanded their hours to cope with demand, yet wait times remained long and frustrating.