These proposals are inconsistent with Medicaid’s core mission of providing comprehensive health coverage to low-income people, as well as with federal requirements that Medicaid waivers advance that objective.Legal challenges are expected if the feds approve and Arkansas implements a tightening of the program. The report explains why working poor will struggle in Arkansas.
If allowed to take effect, Arkansas and Massachusetts waivers would threaten healthcare coverage for thousands of low income adults.
Although many of those affected would be eligible for federal tax credits to help buy coverage in the individual health insurance market, solid evidence (described below) indicates that a sizable number of them would become uninsured, while others would be left with less affordable or less adequate coverage. That’s partly because individual market plans, even with tax credits, are less affordable than Medicaid for people with incomes just above the poverty line. It’s also because some in this group would be ineligible for tax credits because their employer offers them coverage, even though that coverage would require them to pay a substantial share of their income in premiums.
Although both proposals would hurt many people, Arkansas’ would be worse for adults losing Medicaid. Unlike Arkansas, Massachusetts provides additional help to defray premiums and cover other costs to adults with incomes up to 300 percent of poverty who have marketplace coverage. That would help those between 100 and 138 percent of poverty who lose Medicaid, although marketplace plans generally leave out some benefits that Medicaid covers.