Lawmakers open to work requirement for Medicaid

March 20--State lawmakers are open to requiring able-bodied adults on Medicaid to work as part of a proposed expansion of the program in Kansas.

The Senate kicked off two days of hearings on Monday over increasing the number of people eligible for Medicaid, which provides health care for disabled and low-income individuals.

The hearings come ahead of an expected vote in Congress later this week on a Republican bill to overhaul federal health care law that is expected to allow states to impose a work requirement on nondisabled adults in Medicaid. The program, which in Kansas is privatized and known as KanCare, currently does not contain work requirements.

If Congress eventually passes a bill opening the door to work requirements in Medicaid, the change in federal law could hold implications for the Medicaid expansion debate in Kansas.

Some Kansas Republican lawmakers who might otherwise have voted against expansion may support it with a work requirement. Gov. Sam Brownback -- who has voiced opposition to expansion as recently as January -- signaled Monday he would be more open to considering a proposal that includes a work provision.

The House passed legislation last month that would make individuals earning up to 133 percent of the federal poverty line -- $24,600 for a family of four -- eligible for KanCare. The program currently covers more than 400,000 people, and more than 150,000 people could be added under expansion.

The bill doesn't require nondisabled adults to work but mandates referrals to workforce training programs. Full-time college students are exempt from the referrals, and the Kansas Department of Health and Environment can exempt adults with children who live with them.

In past years, expansion legislation didn't advance because of conservative opposition, both from legislative leadership and the governor. After voters installed a number of moderate Republicans and Democratic lawmakers last fall, the dynamic surrounding expansion has changed.

The House passed the Medicaid expansion bill 81-44, three votes shy of a veto-proof majority. Although the bill's prospects are less clear in the Senate, the chamber has a number of new, politically more moderate senators who may be open to voting for expansion.

Even if expansion passes the Legislature, Brownback may veto the bill. He praised lawmakers for not expanding during his State of the State address in January.

In the speech, he said it would be foolish to endorse Medicaid expansion at a time when the new Congress and President Trump's administration are working to repeal and replace the federal health care law and rewrite the Medicaid program, he said.

Brownback has previously outlined conditions that would allow him to support expansion: It must be budget-neutral, Kansas must provide services to eligible disabled individuals on waiting lists before expanding coverage to able-bodied adults, and it must contain a work component.

On Monday, he reiterated those same elements.

"I do think work requirements are important, because it really does help people get out of poverty," Brownback said.

The financial impact of expansion is also important, he said, because of the Kansas Supreme Court's order that the Legislature must develop a new school finance formula by the end of June. The justices found the current funding system inadequate, and estimates place the amount of additional spending needed to satisfy the court anywhere from $400 million to more than $800 million.

State estimates show expanding Medicaid would cost Kansas about $31 million next fiscal year and more than $67 million the year after, under current federal law.

The Senate Public Health and Welfare Committee will debate and potentially vote on the expansion bill later this week. If the panel approves the measure, it heads to the Senate floor.

Senators on the panel said they would be open to considering a work requirement.

"It would certainly make me more receptive, too," said Sen. Ty Masterson, R-Andover, one of the more conservative members of the Senate.

Sen. Barbara Bollier, R-Mission Hills, who supports expansion, said she's not opposed to a work requirement but that it must be done in a "thoughtful way."

Many people in the coverage gap are working, she said, but have no benefits. Others may have mental health issues that prevent them from working full time, she said.

According to a 2016 analysis by the Kaiser Family Foundation of census survey data, 41 percent of those in the coverage gap were in a family with a full-time worker, while 21 percent were in a family with a part-time worker. Thirty-eight percent were in families with no one working.

"If they're not (working), there's probably a pretty good reason for that," such as mental health issues and disabilities, said Sen. Laura Kelly, the ranking Democrat on the health committee.

Jonathan Shorman: 785-296-3006, @jonshorman

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