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Advocates say having computer programs decide how much help vulnerable people can get is often arbitrary – and in some cases downright cruel.

Kevin De Liban, an attorney with Legal Aid of Arkansas, began fighting the cuts after severely disabled patients started calling “en masse” in 2016. “The human suffering was just immense,” he said. “You had people lying in their own waste. You had people getting bed sores because there’s nobody there to turn them. You had people being shut in, you had people skipping meals. It was just incalculable human suffering.”

About two years ago, Medicaid enrollees in Arkansas were discovering a new reality: if they wanted to keep their health coverage, they would have to navigate a complex, finicky state website every month to report that they were working, in school, or volunteering for at least 80 hours. Arkansas was the first state to ever impose a work requirement on Medicaid coverage, the government-run health insurance program for the poor. After the Trump administration had welcomed states to seek its approval for imposing work requirements in the program, another 18 eventually tried to do the same thing; the administration approved waivers in eight of those states.

Medicaid Work Requirements Appear to be Dead