by Sam Whitehead, KFF Health News, Phil Galewitz, KFF Health News and Katheryn Houghton, KFF Health News, Arkansas Advocate
May 2, 2025

For many years, Eric Wunderlin’s health issues made it hard to find stable employment.

Struggling to manage depression and diabetes, Wunderlin worked part-time, minimum-wage retail jobs around Dayton, Ohio, making so little he said he sometimes had to choose between paying rent and buying food.

But in 2018, his CareSource Medicaid health plan offered him help getting a job. It connected him to a life coach, who helped him find full-time work with health benefits. Now, he works for a nonprofit social service agency, a job he said has given him enough financial stability to plan a European vacation next year.

“I feel like a real person and I can go do things,” said Wunderlin, 42. “I feel like I pulled myself out of that slump.”

Republicans in Congress and several states, including Ohio, Iowa, and Montana, are pushing to implement work requirements for nondisabled adults, arguing a mandate would encourage enrollees to find jobs. And for Republicans pushing to require Medicaid enrollees to work, Wunderlin’s story could be held up as evidence that government health coverage can help people find employment and, ultimately, reduce their need for public assistance.

Yet his experience is rare. Medicaid typically does not offer such help, and when states do try to help, such efforts are limited.

And opponents point out that most Medicaid recipients already have jobs and say such a mandate would only kick eligible people off Medicaid, rather than improve their economic prospects. Nearly two-thirds of Medicaid enrollees work, with most of the rest acting as caregivers, going to school, or unable to hold a job due to disability or illness, according to KFF, a health information nonprofit that includes KFF Health News.

Existing efforts to help Medicaid recipients get a job have seen limited success because there’s not a lot of “room to move the needle,” said Ben Sommers, a professor of health care economics at the Harvard T.H. Chan School of Public Health. Most Medicaid enrollees already work — just not in jobs with health benefits, he said.

“The ongoing argument that some folks make is that there are a lot of people freeloading in Medicaid,” he said. “That’s just not supported by the evidence.”

Using Health Programs To Encourage Work

The GOP-controlled Congress could allow or require states to implement a Medicaid work requirement as part of revamping and downsizing Medicaid. The first Trump administration encouraged those work mandates, but many were struck down by federal judges who said they were illegal under federal law.

Policy experts and state officials say more attention should be paid to investments that have helped people find better jobs — from personalized life coaching to, in some cases, health plans’ directly hiring enrollees.

They argue work requirements alone are not enough. “The move to economic mobility requires a ladder, not a stick,” said Farah Khan, a fellow with the Brookings Institution, a nonpartisan think tank.

While Medicaid work requirements have been debated for decades, the issue has become more heated as 40 states and Washington, D.C., have expanded Medicaid eligibility under the Affordable Care Act to the vast majority of low-income adults. More than 20 million adults have gained coverage as a result — but Republicans are now considering eliminating the billions in extra federal funding that helped states extend eligibility beyond groups including many children, pregnant women, and disabled people.

Only Georgia and Arkansas have implemented mandates that some Medicaid enrollees work, volunteer, go to school, or enroll in job training. But a study Sommers co-authored showed no evidence work requirements in Arkansas’ program led to more people working, in part because most of those who could work already were.

In Arkansas, more than 18,000 people lost coverage under the state’s requirement before the policy was suspended by a federal judge in 2019 after less than a year. Those who lost their Medicaid health care reported being unaware or confused about how to report work hours. Since 2023, Arkansas has been giving Medicaid health plans financial incentives to help enrollees train for jobs, but so far few have taken advantage.

Some plans, including Arkansas Blue Cross and Blue Shield’s, offer members $25 to $65 to complete a “career readiness” certificate. In 2024, some Arkansas health plans offered enrollees educational videos about topics including taxes and cryptocurrency.

Health plans don’t have an incentive to help someone find a better-paying job, because that could mean losing a customer if they then make too much to qualify for Medicaid, said Karin VanZant, a vice president at Clearlink Partners, a health care consulting company.

Rather than offering incentives for providing job training, some states, such as California and Ohio, require the insurance companies that run Medicaid to help enrollees find work.

In Montana, where some lawmakers are pushing to implement work requirements, a promising optional program nearly collapsed after state lawmakers required it be outsourced to private contractors.

Within the program’s first three years, the state paired 32,000 Medicaid enrollees with existing federally funded job training programs. Most had higher wages a year after starting training, the state found.

But enrollment has plummeted to just 11 people, according to the latest data provided by the state’s labor department.

Sarah Swanson, who heads the department, said several of the nonprofit contractors that ran the program shuttered. “There was no real part in this for us to deliver direct services to the folks that walked through our door,” she said. The state hopes to revive job training by allowing the department to work alongside contractors to reach more people.

The Hunt for Results

State officials say they don’t have much data to track the effectiveness of existing job programs offered by Medicaid plans.

Stephanie O’Grady, a spokesperson for the Ohio Department of Medicaid, said the state does not track outcomes because “the health plans are not employment agencies.”

Officials with CareSource, which operates Medicaid plans in multiple states, say it has about 2,300 Medicaid and ACA marketplace enrollees in its JobConnect program — about 1,400 in Ohio, 500 in Georgia, and 400 in Indiana.

The program connects job seekers with a life coach who counsels them on skills such as “showing up on time, dressing the part for interviews, and selling yourself during the interview,” said Jesse Reed, CareSource’s director of life services in Ohio.

Since 2023, about 800 people have found jobs through the program, according to Josh Boynton, a senior vice president at CareSource. The health plan itself has hired 29 Medicaid enrollees into customer service, pharmacy, and other positions — nearly all full-time with benefits, he said.

In 2022, California started offering nontraditional health benefits through Medicaid — including help finding jobs — for enrollees experiencing homelessness or serious mental illness, or who are otherwise at risk of avoidable emergency room care. As of September, it had served nearly 280,000 enrollees, but the state doesn’t have data on how many became employed.

The University of Pittsburgh Medical Center, which is among the largest private employers in Pennsylvania, running both a sprawling hospital system and a Medicaid plan, has hired over 10,000 of its Medicaid enrollees since 2021 through its training and support services. Among other jobs, they took positions as warehouse workers, customer service representatives, and medical assistants.

The vast majority left low-paying jobs for full-time positions with health benefits, said Dan LaVallee, a senior director of UPMC Health Plan’s Center for Social Impact. “Our Pathways to Work program is a model for the nation,” he said.

Josh Archambault, a senior fellow with the conservative Cicero Institute, said Medicaid should focus on improving the financial health of those enrolled.

While the first Trump administration approved Medicaid work requirements in 13 states, the Biden administration or federal judges blocked all except Georgia’s.

“I don’t think states have been given ample chance to experiment and try to figure out what works,” Archambault said.

KFF Health News senior correspondent Angela Hart contributed to this report.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

Arkansas Advocate is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Arkansas Advocate maintains editorial independence. Contact Editor Sonny Albarado for questions: info@arkansasadvocate.com.

The post States Push Medicaid Work Rules, but Few Programs Help Enrollees Find Jobs appeared first on arkansasadvocate.com

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

The article presents a balanced report on the debate surrounding Medicaid work requirements, offering perspectives from both supporters and opponents. It discusses the experiences of individuals like Eric Wunderlin, whose story supports the potential benefits of work assistance through Medicaid, but it also highlights the limitations and challenges of such programs. The article includes multiple viewpoints, notably from critics who argue that work mandates would harm Medicaid recipients rather than help them. Furthermore, the piece acknowledges the lack of success in existing efforts, which is presented in a neutral, factual manner. While the article touches on political dynamics, it refrains from a strong ideological stance, instead focusing on data and expert opinions, contributing to a more nuanced and impartial exploration of the issue. The framing does lean slightly in favor of critiques of the work requirements, but the overall tone remains balanced without a clear ideological agenda.

by Robbie Sequeria, Arkansas Advocate
May 1, 2025

As states rush to address falling literacy scores, a new kind of education debate in state legislatures is taking hold: not whether reading instruction needs fixing, but how to fix it.

More than a dozen states have enacted laws banning public school educators from teaching youngsters to read using an approach that’s been popular for decades. The method, known as “three-cueing,” encourages kids to figure out unfamiliar words using context clues such as meaning, sentence structure and visual hints.

In the past two years, several states have instead embraced instruction rooted in what’s known as the “science of reading.” That approach leans heavily on phonics — relying on letter and rhyming sounds to read words such as cat, hat and rat.

The policy discussions on early literacy are unfolding against a backdrop of alarming national reading proficiency levels. The 2024 Nation’s Report Card revealed that 40% of fourth graders and 33% of eighth graders scored below the basic reading level — the highest percentages in decades.

No state improved in fourth- or eighth-grade reading in 2024. Eight states — Alaska, Arizona, Delaware, Florida, Nebraska, Nevada, Utah and Vermont — scored worse than they did a year or two prior in eighth-grade reading.

Five — Arizona, Florida, Nebraska, South Dakota and Vermont — saw dips in their fourth-grade reading scores.

In response to these troubling trends, a growing number of states are moving beyond localized efforts and tackling literacy through statewide legislation.

New Jersey last year mandated universal K-3 literacy screenings. Indiana lawmakers this month passed a bill that would allow some students to retake required reading tests before being held back in third grade; that bill is en route to the governor’s desk.

Oregon and Washington are weighing statewide literacy coaching and training models, while lawmakers in Montana introduced a bill to allow literacy interventions to cover broader reading and academic skills, not just early reading basics.

Mississippi, a state seen as a model for turnaround in literacy rates over the past decade, seeks to expand and require evidence-based reading interventions, mandatory literacy screenings and targeted teacher training, and to explicitly ban the use of three-cueing methods in reading instruction in grades 4-8.

Together, these efforts signal a national shift: States are treating literacy not as a local initiative, but as the foundation of public education policy.

“Literacy is the lever,” said Tafshier Cosby, the senior director of the Center for Organizing and Partnerships at the National Parents Union, an advocacy group. “If states focus on that, we see bipartisan wins. But the challenge is making that a statewide priority, not just a district-by-district hope.”

‘It’s the system that needs fixing’

Before he was even sworn in, first-term Georgia Democratic state Sen. RaShaun Kemp, a former teacher and principal, had already drafted a bill to end the use of the three-cueing system in Georgia classrooms.

This month, the final version focused on the science of reading passed the state legislature without a single “no” vote. GOP Gov. Brian Kemp signed a similar bill into law Monday to outlaw three-cueing.

Sen. Kemp said his passion for literacy reform stretches back decades, shaped by experiences tutoring children at a local church as a college student in the early 2000s. It was there, he said, that he began noticing patterns in how students struggled with foundational reading.

“In my experience, I saw kids struggle to identify the word they were reading. I saw how some kids were guessing what the word was instead of decoding,” Kemp recalled. “And it’s not technology or screens that’s the problem. It’s what teachers are being instructed on how to teach reading. It’s the system that needs fixing, not the teachers.”

Sen. Kemp’s bill requires the Professional Standards Commission — a state agency that oversees teacher prep and certification — to adopt rules mandating evidence-based reading instruction aligned with the science of reading, a set of practices rooted in decades of cognitive research on how children best learn to read.

“Current strategies used to teach literacy include methods that teach students to guess rather than read, preventing them from reaching their full potential,” Sen. Kemp said in a public statement following the bill’s legislative passage. “I know we can be better, and I’m proud to see our legislative body take much-needed steps to help make Georgia the number one state for literacy.”

In West Virginia, lawmakers have introduced similar bills that would require the state’s teachers to be certified in the science of reading.

Cosby, of the National Parents Union, said local policy changes can be driven by parents even before legislatures act.

“All politics are local,” Cosby said. “Parents don’t need to wait for statewide mandates — they can ask school boards for universal screeners and structured literacy now.”

Still, some parents worry their states are simply funding more studies on early literacy rather than taking direct action to address it.

A Portland, Oregon, parent of three — one of whom has dyslexia — sent written testimony this year urging lawmakers to skip further studies and immediately implement structured literacy statewide.

“We do not need another study to tell us what we already know — structured literacy is the most effective way to teach all children to read, particularly those with dyslexia and other reading challenges,” wrote Katherine Hoffman.

Opposition to ‘science of reading’

Unlike in Georgia, the “science of reading” has met resistance in other states.

In California, legislation that would require phonics-based reading instruction statewide has faced opposition from English learner advocates who argue that a one-size-fits-all approach may not effectively serve multilingual students.

In opposition to the bill, the California Teachers Association argued that by codifying a rigid definition of the “science of reading,” lawmakers ignore the evolving nature of reading research and undermine teachers’ ability to meet the diverse needs of their students.

“Placing a definition for ‘science of reading’ in statute is problematic,” wrote Seth Bramble, a legislative advocate for the California Teachers Association in a March letter addressed to the state’s Assembly Education Committee. “This bill would carve into stone scientific knowledge that by its very nature is constantly being tested, validated, refuted, revised, and improved.”

Similarly, in Wisconsin, Democratic Gov. Tony Evers in March vetoed a bill that would have reversed changes to the state’s scoring system to align the state’s benchmarks with the National Assessment of Educational Progress, a federal assessment tool that has recently been hit with funding cuts and layoffs under the Trump administration. Evers said in his veto that Republican lawmakers were stepping on the state superintendent’s independence.

That veto is another step in the evolution of a broader constitutional fight over literacy policy and how literacy funds are appropriated and released. In 2023, Wisconsin lawmakers set aside $50 million for a new statewide literacy initiative, but disagreements over legislative versus executive control have stalled its disbursement.

Indiana’s legislature faced criticism from educators over a 2024 mandate requiring 80 hours of literacy training for pre-K to sixth-grade teachers before they can renew their licenses. Teachers argued that the additional requirements were burdensome and did not account for their professional expertise.

In Illinois, literacy struggles have been building for more than a decade, according to Mailee Smith, senior director of policy at the Illinois Policy Institute. Today, only 3 in 10 Illinois third- and fourth-graders can read at grade level, based on state and national assessments.

Although Illinois lawmakers amended the school code in 2023 to create a state literacy plan, Smith noted the plan is only guidance and does not require districts to adopt evidence-based reading instruction. She urged local school boards to act on their own.

“If students can’t read by third grade, half of fourth-grade curriculum becomes incomprehensible,” she said. “A student’s likelihood to graduate high school can be predicted by their reading skill at the end of third grade.”

Despite the challenges, Smith said even small steps can make a real difference.

“Screening, intervention, parental notice, science-based instruction and thoughtful grade promotion — those are the five pillars, and Illinois and even local school districts can implement some of these steps right away,” she said.

“It doesn’t have to be daunting.”

Editor’ note: This story has been corrected to reflect the current status of legislation in Georgia. Stateline reporter Robbie Sequeira can be reached at rsequeira@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

Arkansas Advocate is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Arkansas Advocate maintains editorial independence. Contact Editor Sonny Albarado for questions: info@arkansasadvocate.com.

The post As reading scores fall, states turn to phonics — but not without a fight appeared first on arkansasadvocate.com

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Centrist

The article provides a factual overview of the ongoing debate regarding literacy education, specifically focusing on the use of phonics versus the “three-cueing” method. It reports on various states’ responses to falling literacy scores and the legislative efforts to shift towards phonics-based instruction. The content does not express a clear ideological stance but rather documents the different actions taken by state governments and advocates for both sides of the debate. While the article highlights both the push for phonics-based education and the opposition from some educators, it presents these perspectives without promoting one over the other. The tone is neutral, offering balanced coverage of the legislative measures, the challenges involved, and the diverse viewpoints within the education community. There are no strong ideological language or framing choices that would suggest a leaning towards either the left or right. Overall, the article sticks to factual reporting while acknowledging the complexity of the issue, making it centrist in nature.

by Tess Vrbin, Arkansas Advocate
April 30, 2025

Gender-nonconforming Arkansans might not meet the state’s requirements to obtain a REAL ID in order to board flights or enter certain federal buildings, which is a week away from being required by federal law.

Applicants for REAL IDs need to provide the Department of Finance and Administration with four different forms of identification:

A current driver’s license, state-issued ID, or school or work ID as proof of identityA passport or birth certificate as proof of legal presence in the United StatesA government-issued social security cardTwo documents providing proof of address, such as utility bills or bank statements, issued within the last six months

The documents “all have to sync up,” Finance Secretary Jim Hudson said last week.

Transgender and nonbinary Arkansans might have changed their names or gender information on some but not all legal documents, and state policies have made it difficult for these groups of people to obtain documents that accurately reflect who they are, advocates say. Birth certificates can be legally altered, and until this year, the federal government allowed gender-neutral information on U.S. passports.

“The government has played politics with people’s lives and upended people’s ability to accurately and properly identify themselves,” said Holly Dickson, executive director of the American Civil Liberties Union of Arkansas. “This has created much chaos and turmoil for no good reason while making life harder and more unsafe for all of us.”

Last year, the ACLU of Arkansas led a lawsuit against the DFA’s decision to stop issuing gender-neutral driver’s licenses. The case was dropped after Arkansas officials permanently adopted the new policy, which prohibits the use of an “X” to indicate someone’s gender in place of “M” or “F.”

Arkansans urge state finance department not to reverse gender-neutral driver’s license policy

Several transgender and nonbinary Arkansans, including Maggs Gallup of Little Rock, urged the finance department to maintain the previous policy, which had been in place for 14 years. Gallup said in an interview Monday that they are putting off obtaining a REAL ID in case doing so requires the state to remove the X gender marker from their driver’s license.

Hudson told lawmakers that a driver’s license is “not a platform for speech” and “not a platform for personal identity.” Gallup disagreed, saying their gender-neutral ID is important to them and putting incorrect information on an ID is “a deeply incongruent thing to do.”

“In an ideal world, it would be great to have the state and officials recognize our gender,” Gallup said. “They don’t get to determine who we are, no matter what letters we put on our IDs.”

REAL IDs began with a law passed by Congress in 2005 as a response to the Sept. 11, 2001, terrorist attacks. Instituting REAL IDs statewide “will help fight terrorism and reduce identity fraud,” according to the finance department website.

The federal Transportation Security Administration accepts passports in place of REAL IDs as identification to board a flight. Miss Major Griffin-Gracy, a well-known transgender advocate who lives in Little Rock, said last week on Facebook that she was initially denied access to a flight because she has an X on her driver’s license, but she was allowed to board after displaying her passport containing a male gender marker.

Griffin-Gracy is 78 years old and gender-nonconforming, and she was present at the 1969 Stonewall riot between LGBTQ+ people and police in New York City. In her Facebook video, she expressed disbelief that her passport was accepted even though she did not appear masculine. She also said “we the people” should “stand up and fight” President Donald Trump’s administration, which does not recognize gender-neutral IDs.

Gallup said they are also concerned about potential limits on travel, both domestic and international, with or without a REAL ID. Their teenage child is old enough to learn to drive but is putting off obtaining a learner’s permit because of potential bureaucratic obstacles due to their gender-nonconforming identity, Gallup said.

Bill regulating transgender Arkansans’ bathroom use heads to House despite public pushback

“This is just one part of a larger, really complicated network of new rules and legislation that are challenging to navigate” for transgender and nonbinary Arkansans, Gallup said.

State lawmakers and Gov. Sarah Huckabee Sanders approved a law this month that will allow Arkansans to sue for damages if they encounter someone in a bathroom, changing room, shelter or correctional facility who does not align with the “designated sex” of the space.

The state has also enacted laws in the past few years that ban transgender girls from playing girls’ sports, require public school students to use bathrooms that match their gender assigned at birth, regulate pronoun use in schools and allow doctors who provide transgender minors’ health care to be sued for medical malpractice.

Arkansas Advocate is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Arkansas Advocate maintains editorial independence. Contact Editor Sonny Albarado for questions: info@arkansasadvocate.com.

The post REAL ID requirements among policies difficult for transgender, nonbinary Arkansans to navigate appeared first on arkansasadvocate.com

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

The article appears to adopt a Center-Left perspective primarily through its focus on issues affecting transgender and nonbinary individuals, particularly with regard to identity documentation requirements in Arkansas. It emphasizes the challenges faced by gender-nonconforming individuals in obtaining accurate identification and highlights criticisms from the American Civil Liberties Union (ACLU) regarding the state’s policy changes. The language used is sympathetic toward these groups, portraying the state’s actions as creating unnecessary turmoil and being politically motivated. Although the article provides factual information about the REAL ID process and relevant legal actions, its framing leans toward advocacy for the rights of transgender individuals, positioning the state’s policies in a critical light. This reflects a broader pattern of liberal advocacy for gender inclusivity in government identification practices. However, the piece does offer direct quotes from state officials, which helps balance the presentation of opposing views. Thus, the overall tone remains more supportive of progressive policies on gender identification, hence the Center-Left categorization.