Many Medicaid recipients skipping premiums in states that require them

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Tens of thousands of Medicaid enrollees are opting not to pay premiums In the five states that require them.

A review of state records in Arkansas, Indiana, Michigan, Iowa and Montana found that many of those offered care in exchange for contributions after passage of the Affordable Care Act in 2014 simply aren't paying — and yet keep their coverage.

Arkansas leaders debated whether to renew the state's Medicaid expansion in 2016, and many Republican lawmakers agreed to do so only if they could bill 300,000 adults who gained coverage.

This "skin-in-the-game" provision is designed to make Medicaid recipients value their government health insurance more and lead healthier lives, according to a CNN Money article.

In 2017, just 20% of the 63,000 Arkansas enrollees whose income outpaced the poverty level paid their $13 monthly premiums. The state's Medicaid program doesn't cut coverage for failure to pay.

Under the ACA, states received millions of federal dollars to cover everyone with incomes under 138% of the federal poverty level. Until then, Medicaid typically covered only low-income children, disabled adults and parents.

Kentucky has received approval to add premiums to its Medicaid program in 2018.

Even when recipients agree with premium policies, they aren't necessarily willing to pay.

Michigan requires higher-income Medicaid enrollees to pay about 2% of their income in monthly premiums. Kaiser Health News reported a survey of enrollees last year found nearly 88% said the amount billed was "fair," but between January and August, just 77,000 of 175,000 (or 44%)  paid it.