Nannette Ruelle is watching three numbers tick downward as the year comes to a close. The first is the number of doses left in her Advair inhaler, which she normally uses three times a day to control her asthma. As of Nov. 17, she had 35 remaining. The second is the number of pills in her bottle of Gabapentin, which her doctor told her to take three times daily for chronic neuropathic pain in her feet and ankles. She had three as of Nov. 17.
The third is the number of days left until she can refill those prescriptions: 44. She was kicked off her Arkansas Works health insurance in September and will be locked out until Jan. 1.
Ruelle, 38, lost her coverage at the end of August due to Arkansas's new requirement that certain Medicaid beneficiaries report their work hours to the state. For the past two-and-a-half months, she's been carefully rationing both her medications, allowing herself a Gabapentin only when the nerve pain becomes so bad she fears she won't be able to do her job. Ruelle works 25-35 hours a week at a chain restaurant in Little Rock, where she makes $9 an hour.
"It's some serious stuff. They're just playing around with people's lives, and I don't think it's fair," she said in a recent interview. "What if I wake up one morning and I can't even function because my feet are hurting and I have nothing left?"
Ruelle said she first recalled hearing about the requirement in May, when she was working a minimum wage job at a different restaurant. The instructions on the notice she received from the state Department of Human Services were confusing, but she tried to do what the letter demanded.
"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 said.
When she got no reply after leaving voicemails and visiting her local DHS office, Ruelle said, she gave up. "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.' "
Over the last three months, DHS has removed 12,277 people from Arkansas Works the state's Medicaid-funded insurance program for low-income adults for not reporting their work hours. Thousands more will likely join them in December. The rule, which began for the first subset of beneficiaries in June, requires able-bodied adults under age 50 to report at least 80 hours of "work activities" each month. (In 2018, the requirement applied only to those ages 30-49, but it will begin including 19- to 29-year-olds in 2019.) Those who don't comply for any three months in a calendar year are kicked off Arkansas Works and locked out until the new year begins.
Ruelle's attempts to reach DHS were unsuccessful in part because the agency only allows people to report their work hours through a website, rather than by fax, phone or mail. This online-only requirement is unlike any other reporting required by DHS. The agency places no such restriction on the way beneficiaries submit other information, such as a change of address just their work hours.
DHS first sends Arkansas Works recipients who must meet the work requirement a letter directing them to https://access.arkansas.gov. As of Nov. 16, that URL sent users to a general DHS landing page containing information about voter registration, not health insurance. From the landing page, a beneficiary must navigate a series of menus to reach a login page, where he or she is prompted to create a new account. (Doing so requires an active email address.) Then, the user must locate a unique "reference number" contained on the letter from DHS "to link your online account to your healthcare coverage." Only then can the beneficiary enter work hours.