I recently spoke with Cindy Gillespie, a former health care advisor to Mitt Romney and the current director of the Arkansas Department of Human Services, about what the work requirements do and don’t mean for Arkansans. We met at the Spotlight Health Festival, which is cohosted by The Aspen Institute and The Atlantic. A lightly edited transcript of our conversation follows.
Olga Khazan: Do you have any concerns that the work requirements on Medicaid will cause people to lose coverage, and if not, why not?
Cindy Gillespie: We’ve started our work requirements with the 30- to 49-year-old group. Within the 30-to-49-year-old group, we’ve exempted out anybody with a child in the home, anyone who is caring for an incapacitated person, anyone who has a short-term incapacitation, drug, and alcohol rehab.
We end up with a small population of able-bodied adults who are working less than 80 hours a month and, who, as best we can tell, are not full-time students or not in any sort of activity that would prevent them from being able to get into job training, job search, education, some kind of GED, all of these different type of areas. Our focus is to get those individuals … get them working with the Department of Workforce Services, career education, someone who can help them identify what their barriers are to actually looking for a job, getting a job, engaging in the community, doing volunteerism, doing job search, all of those sorts of things.
Our focus is to really concentrate on those individuals and see if we can move them further up the economic ladder. After three months of non-compliance, a person will lose their coverage for the rest of the plan year. Not permanently. If the individual does not, for some reason, engage in that period, they can come back into the program in the next plan year.
Khazan: Why not just do the engagement into the programs and not have the stick of the losing coverage?
Gillespie: Last year we tried a work referral, where we tried to refer everyone in the program to all the different services that were available. We had an extremely low take-up rate. People just didn't pay attention. This is actually engaging, not just the individuals, but it is engaging an entire support network around them.
For example, the insurance carriers, they have a vested interest in that person now because [if] that person rolls off the insurance plan, then that carrier won't be getting paid for them anymore. They have a vested interested in putting their network to work, reaching out and getting with the person. The same with all of the groups that work around the state with different individuals. They all have a vested interest now in helping make sure that the individuals do, in fact, get into the system.
Our department of Workforce Services actually sent all of our Arkansas Works beneficiaries a letter and told them ... We want to help you get, to education, to job training, to job search, to what you need.