Arkansas implemented Medicaid work requirements in June of 2018. To maintain coverage in the state, adults ages 30-49 were required to work 20 hours a week, participate in “community engagement” activities, or qualify for an exemption. By April 2019, when a federal judge halted the policy, more than 18,000 adults had lost coverage. As an update to research published in 2018, Benjamin D. Sommers, Lucy Chen, Robert J. Blendon, E. John Orav, and Arnold M. Epstein analyzed the policy effects before, during, and after implementation in this Health Affairs brief.  


The research team conducted a telephone survey to compare changes in outcomes before and during the implementation of work requirements, in 2016 and 2018 respectively, and after the policy was halted by a federal judge in 2019. They compared changes in employment and health-related outcomes of Arkansans ages 30-49 to that of Arkansans ages 19-29 and 50-64, as well as to three states not implementing work requirements (Kentucky, Louisiana, and Texas).

They Found:

  • Most of the Medicaid coverage losses that occurred in Arkansas in 2018 were reversed in 2019 after the policy was halted by the courts.
  • Work requirements did not increase employment or other “community engagement” activities over 18 months of follow-up.
  • Coverage losses caused by the work requirements were associated with difficulty paying medical debt and delays in seeking care due to costs.
  • Confusion about the work requirement policy remains an ongoing challenge, with most low-income adults in the state unsure if the policy is currently in effect.

Implications for Policy and Practice

Arkansas served as the initial testing ground for work requirements as a condition of coverage under Medicaid. Advocates of the policy contend that it will help improve health and increase employment among low-income adults, but new data suggest implementation of the policy has had adverse effects.

Overall, work requirements in Arkansas led to coverage losses and were associated with increases in medical debt and decreases in affordability of care, without achieving the principal goal of improving employment. Despite the court’s reversal of this policy, significant confusion and misinformation remain – 70% of Arkansans were uncertain about whether the policy was still in effect and only 6% were aware that it had been put on hold. The findings from this study raise the concern that work requirements may negatively affect application for or renewal of Medicaid coverage, even when they are no longer in effect. In considering similar work requirement policies in the future, federal and state policymakers should understand that this research showed that the Arkansas policy failed its stated goals of promoting work and instead led to substantial evidence of harm given reduced health care coverage and access.

Related Evidence

  • Published June 19, 2019

    In June 2018, Arkansas became the first state to implement work requirements in Medicaid. Benjamin D. Sommers, Anna L. Goldman, Robert J. Blendon, E. John Orav, and Arnold M. Epstein of Harvard University provide the first independent assessment of early changes in beneficiary coverage and employment after the work requirements went into effect.

    View Evidence