Arkansas is one of five states for which CMS has approved a Section 1115 waiver to condition Medicaid eligibility on meeting work and reporting requirements and the first state to implement this type of waiver. Unless exempt, enrollees must engage in 80 hours of work or other qualifying activities each month and must report their work or exemption status using an online portal by the fifth of the following month. The new requirements were phased in from June through September, 2018 for Arkansas Works enrollees ages 30 to 49, and will apply to those ages 19 to 29 beginning in 2019. Enrollees subject to the new requirements have annual incomes up to $16,753 (138% of the federal poverty level for an individual in 2018). As of December 2018, nearly 17,000 people have been disenrolled due to the new requirements. This brief builds on our prior analysis of state data and a case study published in October 2018, to include perspectives of enrollees and providers about the new "Arkansas Works" waiver requirements. The findings are primarily based on four focus groups with a total of 31 Arkansas Works enrollees conducted during November 2018, in Little Rock and Monticello, Arkansas to capture both more urban and rural experiences. Focus group participants included those currently subject to the new requirements and some who have lost coverage as a result of the new requirements as well as those who will become newly subject to them in 2019. They may not be representative of all Arkansas Works enrollees as they were successfully contacted via phone and email and had transportation to the group location. To account for these differences and provide a fuller picture of how enrollees are experiencing the new requirements, we also conducted interviews with four safety net health care and food assistance providers in November, 2018. Focus group and interview findings provide new insights into key questions about the early implementation of the new requirements and their impact on enrollees, including: (1) Are enrollees aware of the new requirements and if so, what is their experience setting up online accounts? (2) What effects are the new requirements having on enrollees' participation in work activities? (3) What effect is the monthly reporting requirement having on enrollees? (4) What effect are the new requirements having on individuals with more complex needs? (5) What are the effects of coverage losses due to failure to satisfy the new requirements?
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