3. The Medicaid program is a persistent focus of calls for delivery system reform. Describe, with supporting evidence, the reason(s) that Medicaid is a target for reform. Compare and contrast the goals and characteristics of two (2) proposals for Medicaid reform and the potential benefits and/or harms for Medicaid beneficiaries and other stakeholders (providers, state, local governments, etc.) associated with the identified proposals. Which proposal, if any, would you recommend? Why?

Medicaid is a target for reform because it provides health insurance coverage for twenty percent of Americans, is the largest payer for long term care, and finances approximately twenty percent of all personal healthcare spending in the country.13,14 In addition, Medicaid is administered on the state level, causing substantial differences in the program across all fifty states.14 Medicaid also provides insurance coverage for children, the elderly, and people with disabilities in addition to covering people with low income.13 Ultimately, Medicaid is a significant payer whose state-run programs have significant variation and affect a significant portion of the U.S. population, generating a need for reform.
One of the main routes to reforming Medicaid in 2019 is through Medicaid demonstration waivers, which provides states the opportunity to trial programs that are not otherwise allowed under current law and objective requirements of Medicaid.13 Two areas of interest for multiple states are waivers for work-requirements to receive Medicaid and waivers for addressing the ongoing opioid crisis.
Arkansas Works is a demonstration waiver aimed at increasing the employment level of Arkansas’ Medicaid population by mandating certain reporting requirements for work and job search hours in order to receive Medicaid program benefits.15 According to the Arkansas Department of Human Services, Arkansas W