Under the Same Sky featuring David Jacobson
David Jacobson, Medicaid Managed Care Expert, Leader, and Consultant, Former Health Plan Executive
Under the Same Sky featuring David Jacobson
Abner Mason sat down with David Jacobson, a longtime Medicaid managed care leader and former Arkansas health plan executive, to discuss one of the most consequential changes coming to Medicaid in more than a decade: the implementation of national work requirements in 2027.
David brings rare firsthand experience. He had a front‑row seat in Arkansas back in 2018, when it was one of the only states to fully implement Medicaid work requirements, and he’s spent his career shaping programs focused on access, innovation, and whole-person care. His insights offer both a cautionary tale and a roadmap for what states and plans must do differently this time around.
The following provides a summary of David’s advice on lessons learned and key considerations every state leader and health plan executive should take note of.
Arkansas did nearly everything “right” and still faced major challenges
Arkansas invested heavily in outreach, communication, call centers, and technology, but the results were sobering:
- 18,000 people (25%) lost coverage in just nine months, primarily for procedural, not eligibility, reasons.
- Members struggled with a confusing process, portal failures, and an overwhelming administrative burden.
- Many beneficiaries didn’t even know they were on Medicaid due to the state’s unique “private option” expansion model.
David’s takeaway: even strong planning cannot overcome system complexity without deep, person-centered design and real-world testing.
Work requirements add complexity to an already hard-to-navigate program
The conversation highlighted familiar barriers such as outdated contact information, hard-to-reach members, and significant rural digital divides, but work requirements multiplied these challenges.
Key friction points included:
- Multiple new steps for documentation and exemptions
- High system failure rates
- Administrative overload for members and call centers
- Edge cases (gig workers, seasonal workers, students) that systems weren’t designed to handle
Most noncompliance wasn’t intentional; people tried and couldn’t succeed due to structural issues.
David’s “Community Engagement Opportunity (CEO) Model” offers a path forward
Drawing on lessons from Arkansas, David developed the CEO Model, a framework designed to modernize Medicaid while meeting federal requirements.
The model centers on:
- Human-centered design
- Collaboration across states, CMS, plans, and community-based organizations (CBOs)
- High-touch support paired with smart technology and AI
- Real-time adaptability as issues surface
His message: there is no silver bullet, but an integrated approach can prevent widespread, unnecessary disenrollment.
Ten months to prepare: A month-by-month strategy
With work requirements beginning in January 2027, time is short, especially given look-back periods that start earlier.
David outlined a clear preparation timeline:
- Q1 2026: Set strategy, identify risks, assign leaders, complete environmental scans
- Q2 2026: Begin collaboration across sectors, design systems, select technology partners, and integrate CMS rules (expected June 1)
- Q3 2026: Build and test tools, launch early education, begin large-scale member communication
- Q4 2026: Finalize systems, pilot processes, and roll out full outreach and support
- January 2027: Go live with daily/weekly monitoring, rapid troubleshooting, and KPI-driven improvement loops
His strongest advice: don’t wait. Begin preparing now.
The stakes are high, but we can do better
Both Abner and David emphasized a shared goal: qualified people should not lose coverage because of administrative hurdles. If statesand plans learn from past missteps and leverage the insights of people like David,community partners, and managed care organizations, we can prevent avoidable losses and strengthen Medicaid for the long term.
As David put it:
"Let’s keep qualified people enrolled so they can stay healthy. We’re all capable, this too shall pass, and in the end, the program can emerge stronger."
