Advocates say Medicaid work proposals will target women

March 05--Ashley Edwards had a few questions Monday about a move to impose work requirements on a small and mostly-female population receiving Medicaid benefits.

"Who is going to help recipients find gainful employment?" Edwards said at a public hearing on the proposed changes. "Who will provide child care for recipients who get gainful employment? Will new caseworkers be hired or will the state rely on already-overburdened workers?"

The comments came amid Alabama Medicaid's proposal to impose some work requirements on the parent and caretaker (POCR) population, a group of about 74,000 people who represent virtually the only able-bodied adult population that receives Medicaid benefits in Alabama.

Most of Alabama's 1 million Medicaid recipients are children, elderly or the disabled. The POCR population consists of parents -- at least three-fourths of whom are women -- of Medicaid-eligible children. They can qualify for benefits, but income requirements are strict. Recipients must make 18 percent of the poverty line or less, equal to $2,963 a year for a household of two and $3,740 a year for a household of three.

A person working a weekly 40-hour minimum wage job makes $1,160 a month before taxes.

"It leaves me feeling that we are making an attempt to demonize poverty," said Robert Kennedy Jr., a former U.S. Senate candidate and current U.S. House candidate. "The people actually receiving benefits today aren't receiving them because they want to receive these benefits. They receive them because they are in dire financial straits."

Alabama Medicaid estimates each person in the POCR population costs an average of $5,837 a year. That's more than the $2,685 cost per child, but well below the $16,625 it costs to provide care to the program's aged, blind or disabled population.

The agency said in its waiver application that it believed "increasing employment among parents and caretakers through employment and job training requirements will improve health outcomes and economic security among this population and their families." Work would include full-time employment, job or technical training, education activity or volunteer work.

The agency wants to exclude disabled individuals; pregnant women; people over the age of 60; people taking care of a disabled child or adult and people undergoing addiction treatment from the work requirement.

It is not clear how many current enrollees the changes would affect. A public document issued by the department projects that the POCR population would stand at 67,543 in 2023, which the agency said would be 17,000 fewer than projected that year.

Critics of the move did not dispute the benefits of labor but said the state fails to provide the kind of support -- particularly for child care and transportation -- that those in poverty need to make the transition to the workforce.

"Even if they could find work and pay for health care, they're faced with child care needs," said Linda Lee, executive director of the Alabama chapter of the American Academy of Pediatrics. Medicaid plays a major role in keeping pediatric offices in the state open.

Other states, like Kentucky, have moved to impose work requirements on their Medicaid populations, but unlike Alabama, most of those states have expanded Medicaid eligibility to anyone making 138 percent of the poverty line -- $16,753 a year for an individual and $34,368 a year for a family of four.

Lee and other speakers also said losing insurance would either make households more vulnerable to illness or force them to choose between health care and other needs. Carol Gundlach, a policy analyst for Alabama Arise, said she could "not see how the loss of parental insurance can possibly benefit children."

"It's critical to remember that the real intent of this proposal is to take health insurance away from women targeted by the waiver request," she said.

Edwards also noted that the POCR population already has a host of responsibilities.

"Parenting and caretaking is work," she said. "For there to be an implication that people taking care of people under the age 19 or other disabled adults are not working is quite incorrect. Bringing up the next generation of children is quite honorable."

The agency plans its second and final public hearing on the proposal at the Hoover Public Library in Hoover Tuesday at 11 a.m. Alabama Medicaid will solicit comments on the proposal until April 2 at publiccomment@medicaid.alabama.gov.

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