Introduction
Arkansas has used the Medicaid Demonstration Waiver 1115 to execute its Medicaid program, which offers coverage of health care for low-income people of the state. The waiver has enabled the state to test new ways to Medicaid coverage to enhance health outcomes and lower costs. The Medicaid demonstration waiver program in Arkansas was established in 2018 as part of the Arkansas Works scheme (McNally, 2023). By the close of that year, about 17,000 people had lost Medicaid coverage due to failure to meet the work and community involvement standards (Sommers et al., 2019). It accounted for almost 20% of the number of individuals susceptible to the regulations. The function of the Medicaid Waiver towards the deployment of Arkansas works programs are examined in this case study. The study will analyze the impact of Multiple Theory streams on program development, as well as the present state of Arkansas’ Work Requirements policy.
Problem Statement
Policy change, as per Kingdon’s “Multiple Streams Theory,” is the result of three separate and interrelated streams of action. Integrating the policy, problem, and politics streams in a possibility, which arises when these streams interact and a policy shift is likely (De Wals et al., 2019). The problem stream depicts the concerns or difficulties that legislators and the general public regard as serious problems that necessitate policy intervention.
Concerns over rising healthcare expenses and the number of people on Medicaid drove the problem stream in the context of the Medicaid 1115 program in the Arkansas Work Requirement program. As healthcare expenses grew, states, along with Arkansas, began to search for ways to cut costs and boost the effectiveness of their medical practices. Medicaid, which offers health insurance to low-income people, was identified as a major contributor to growing healthcare expenses (Goudie et al., 2020). Furthermore, the enormous number of people on Medicaid was viewed as proof of a reliance on government support, which officials tried to diminish.
The Arkansas works program sought to address these concerns by mandating certain Medicaid clients to meet work and community involvement criteria to maintain their healthcare coverage. The program’s purpose was to minimize the number of people on Medicaid and foster self-sufficiency. The strategy was viewed as a response to the identified problems of escalating healthcare costs and government dependency. The problem stream, however, was not confined to rising healthcare prices and the number of people on Medicaid. Concerns were expressed in the Arkansas works program regarding the risk of harm to vulnerable individuals, notably individuals with disabilities, chronic diseases, and mental health disorders who may be unable to meet the job and community engagement criteria. Advocacy groups and legal battles expressed these concerns, arguing that the policy could hurt vulnerable populations and contravene the Medicaid program’s intent.
Discussion of Kingdon’s Policy Stream
The Kingdon’s model is divided into three “streams” which must all interact for legislative change to take place. First, the problem stream includes concerns that affect policymakers and the general population. Second, proposed policies and solutions created by experts, advocacy groups, and policy managers comprise the policy stream. Third, the political stream includes the political climate, which comprises politicians’ agendas, elections, and public sentiment. In the Arkansas ‘case, the policy stream offers a variety of remedies or policy solutions for dealing with the difficulties identified in the problem statement. In the case of the Arkansas work requirement program’s Medicaid 1115 program, the policy stream was focused on offering a policy response to the concerns of rising healthcare costs and perceived dependency on government assistance.
Arkansas Works was established as a possible solution to these issues. To continue accessing healthcare, some Medicaid participants were forced to complete work and community activity criteria under the Arkansas Works program (Sommers et al., 2018). The policy was to boost self-sufficiency and reduce the number of persons on Medicaid. The idea was that it would motivate individuals to work and earn money, lessening their reliance on government assistance. Yet, the policy stream was not without its obstacles. One of the toughest dilemmas was deciding how to categorize employment and community involvement activities. Some claimed that some activities, such as volunteering and education, might help meet the employment and community engagement requirements, while others said that only paid employment could qualify.
Discussion of Kingdon’s Political Stream
A range of political issues influenced the political stream in the context of the Medicaid 1115 program under the Arkansas work requirement program. The political atmosphere in Arkansas during the era the policy was adopted was a crucial role. Arkansas had a Republican parliament, and governor both of which supported policies that encouraged self-sufficiency and minimized government help. This political context made measures like the Arkansas Works program more likely to be implemented.
The participation of interest organizations and stakeholders was another political aspect that influenced the passage of the Arkansas works initiative. Interest groups, such as advocacy organizations and healthcare providers, were influential in determining the policy debate. Furthermore, legal battles against the policy stated that it contradicted the purpose of the Medicaid program, which influenced the political flow. These difficulties brought the program to national notice and heightened public scrutiny, putting pressure on officials to re-evaluate the approach. The Arkansas Work Requirement program’s political stream was distinguished by a complex interplay of political elements such as the political atmosphere, lobby groups and decision-makers, and issues.
Current Status of Arkansas’ Work Requirement
Arkansas’ labor requirement program was phased down in 2021 and was introduced under the Medicaid 1115 waiver. It compelled certain Medicaid recipients to complete job and community activity requirements in order to maintain their healthcare coverage (Huberfeld, 2021). Yet, a state judge ruled in 2019 that the clause was illegal because it contradicted the Medicaid program’s aim of providing health care to low-income people (Biden, 2021). After the court decision, Arkansas suspended the labor requirement program as well as the implementation of a similar scheme that was in the works. Furthermore, the state intended to discontinue the Medicaid 1115 waiver (Biden, 2021). This served as the foundation for the work requirement system and revert people to standard Medicaid coverage.
Whilst the work requirement program is no longer in place, the dispute over Medicaid work requirements continues. In 2018, the Trump administration issued a policy allowing states to impose work requirements on Medicaid recipients, and several states, along with Arkansas, followed suit (Huberfeld, 2021). However, the program was challenged in court and was suspended by the Biden government in early 2021 (Biden, 2021). Work requirements supporters claim that they foster self-sufficiency and reduce reliance on government help, while opponents claim that they damage disadvantaged groups and fail to accomplish their intended purposes. The argument over employment requirements emphasizes the complexities of healthcare reform and the importance of carefully considering the potential consequences of policy solutions.
Conclusion
Kingdon’s “many streams theory” is a useful tool for analyzing healthcare policy formation and execution, and it can assist shape future policymaking in Arkansas and elsewhere. Finally, the work requirement program in Arkansas was created as part of the Medicaid Waiver 1115 program, and it required certain Medicaid patients to meet job and community participation criteria to continue receiving health insurance. However, a federal judge ruled that the policy was illegal, and Arkansas ended the program. The Medicaid waiver 1115 program in Arkansas exemplifies the complexities of healthcare policy and the significance of recognizing the elements that influence agenda-setting.
References
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