Implementing States’ Medicaid Wishes Won’t Be Cheap
Last month, the Trump administration opened the door for states to, among other things, make employment a condition for Medicaid, the insurance program for the poor. It has already approved
Much of the debate concerns the impact these requirements will have on the poor. Supporters of strict eligibility requirements believe government assistance programs should encourage people to work and escape poverty. Critics, meanwhile, focus on the people who will lose health insurance in the process and believe health care is key to getting and keeping jobs.
But ideological differences aside, health policy experts warn that changing decades-old rules and systems won't be cheap.
"Our concern isn't whether it's good or bad. But we want them to know there are costs involved," says
Two Big Costs
There are two big costs that come with implementing these kinds of changes, according to experts. There's the IT side: updating systems that house beneficiary data, in some cases creating entirely new ones. And then there's the personnel side: hiring more staff to track compliance and appeals, and training existing staff on the new requirements.
Medicaid, however, isn't the first government program to add work requirements. In the 1990s, federal law called for the condition to be added to welfare (formally called Temporary Assistance for Needy Families, TANF).
When
In most cases, states can get the feds to pick up part of the tab. States can receive a federal match for new administrative costs. Most of the time it's 50 percent, but
But the federal government said in a letter to state Medicaid directors last month that it would not help pay for "job training or other employment services, child care assistance, transportation, or other work supports to help beneficiaries prepare for work or increase their earnings."
States will be on the hook for big sums at a time when many state budgets are strapped. According to the
"I don't know if states realize how fundamentally they'll have to change their eligibility systems," says
Case in point:
In
Similarly, in
'Shifting Spending From Health Care ... to Administrative Bureaucracy'
States aren't just adding work requirements. Some are going to start kicking people off their insurance plan for months at a time if they fail to report a change in income, pay premiums or submit paperwork that proves they're still eligible.
Creating a system that will track employment, premium payments and other metrics will all be significant modifications. Four states are also proposing a time limit for how long people can receive Medicaid. CBPP's Wagner says she's seen firsthand how complicated that can be to track.
When time limits were placed on certain food stamp recipients, she was working as a caseworker in
To account for the added costs, Myers, of Medicaid Health Plans of America, says it's reasonable to expect that some states may trim other areas of their budget -- health or otherwise.
Some states, however, are already being cost-conscious.
In an email to Governing,
And before
"Our serious concern here is that they are shifting spending from health care for needy families to administrative bureaucracy and contracts with private vendors, and leaving families without access to health care," says Wagner.
Experts expect some states to outsource these system updates, but how the states communicate what they want and what the vendors will actually be able to do might be two separate things.
"There's a lot of space between [the state's wishes] and reality," says Myers.
Then there's the issue of manpower. Staff will need to be retrained to learn the ins and outs of the new requirements, and more people may need to be hired to keep up with increased compliance efforts. Some experts say this runs counter to how Medicaid has been run.
"Medicaid is a different beast than SNAP [otherwise known as food stamps] or TANF. SNAP and TANF rely more on interviews and one-on-ones with caseworkers. Medicaid is more streamlined. You can often sign up for eligibility online," says Wagner.
Myers doesn't dispute that getting more Medicaid recipients in the workforce is a good thing. But he's concerned that state officials aren't thinking about all the costs involved to make it happen.
"We just try to say 'sounds great, we can help you, but these are things we hope you're thinking about.'"
This is part of the Health newsletter. Subscribe for free.
___
(c)2018 Governing
Visit Governing at www.governing.com
Distributed by Tribune Content Agency, LLC.
A.M. Best Downgrades Credit Ratings of Kenya Reinsurance Corporation Limited
LegalShield’s James Rosseau Joins Conference Board Economics Watch Webcast to Discuss LegalShield Index Data
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News