‘They don’t value the insurance’: Arkansas official on why thousands lost health care coverage

More than 12,000 people lost Medicaid due to work requirements -- but don't actually fault the new policy, says state official.

Screenshot of Director of the Arkansas Department of Human Services Cindy Gillespie
Screenshot of Director of the Arkansas Department of Human Services Cindy Gillespie

As of November 1st, Arkansas booted more than 12,000 people off Medicaid for failing to report work hours online for three months — but don’t blame the policy, blame the people said one official.

Of the 69,000 Arkansas residents subjected to Medicaid work requirements, less than one percent (557) reported 80-hours of work or community engagement activities per month, as required by the new Arkansas policy implemented in June. Residents, who qualify for Medicaid because they earn up to 138 percent of the poverty level, are only able to report online and the website shuts down every day at 9 p.m.

While there’s plenty of expert analyses showing the process is too complicated and that barriers to internet access exist, the director of the Arkansas Department of Human Services Cindy Gillespie offered the PBS NewsHour an optimistic take, asserting that the confusion will ultimately resolve with time. Nevertheless, she insisted that some of the Arkansans affected are currently uninsured now because they don’t value insurance.

Reporter Catherine Rampell: How would you explain the fact that something like 80 or 90 percent of people who are required to report work hours are not reporting work hours? They’re too unmotivated?

Gillespie: Some are. Some are just not — they don’t value the insurance. They’re not using it. They don’t value it — would be part of it, I do hear from some people. For others, it might also be the case that they don’t know that they’re insured and don’t care to be insured if they received a notice.

Rampell: I would find it very surprising that people don’t want to be insured if it’s not costing them anything.

Gillespie: But it starts to cost them something if they then have to begin to engage in activities, report income that they don’t want to report, etc.

But a closer look at the state’s own data shows most people are likely unaware of the new policy: About 54,000 recipients are exempt without having to do anything; more than 960 are already meeting the requirement because food assistance requires them to; and more than 12,000 failed to report and are now without health coverage.


A simple Google search turns up multiple expert analyses on why people failed to meet the work requirement. A Kaiser Family Foundation analysis based on interviews with key stakeholders in August and September found that the state’s outreach campaign was a failure, as many people didn’t answer calls or return messages. Lack of computer literacy and internet access also created problems for ongoing reporting; Arkansas has one of the lowest levels of internet access country-wide. Health Affairs interviewed more than a dozen Medicaid beneficiaries, none of whom devalued insurance as Gillespie claimed. In fact, some had chronic diseases such as drug addiction, and thus dependent on Medicaid for their own survival.

In one particularly harrowing account, Little Rock resident Nannette Ruelle described to the Arkansas Times’ Benjamin Hardy how she lost her insurance in August and has had to ration medications for the past two-and-a-half months. Ruelle, who works about 25 to 35 hours a week at a local restaurant, carefully parcelling out a medication to treat “chronic neuropathic pain in her feet and ankles” so she can continue working, told Hardy that she failed to report her hours because the system was too difficult to navigate.

“What happened was that I got my information and I tried to fax it to them. The fax wouldn’t go through, so I tried calling them, and I never got an answer on the phone. I went up there and they were out of the office,” she told the Arkansas Times. “I just quit trying, because you can only try so many times before it’s like, ‘OK, you’re closing the door in my face.’ ”

State data shows more than 6,000 failed to meet the work rule for two consecutive months already. If they fail to report again in November, thousands can lose Medicaid benefits December 1st.