Learn more about how Louisiana might require Medicaid recipients to work for coverage

Feb. 11--Louisiana is on track to become one of the next states to seek approval to require some Medicaid recipients to work to keep their health care coverage.

The idea is among a wish list that House Republicans presented to Gov. John Bel Edwards in negotiations over the looming state budget shortfall.

Edwards included Medicaid work requirements among the items in his call for a special session that will begin Feb. 19.

But Edwards, a Democrat, has already been working behind the scenes on the idea, which is more often embraced by Republicans.

The specifics haven't been hammered out, but Andrew Tuozzolo, a spokesman for the Louisiana Department of Health, said work is underway on developing a Louisiana-specific model for work requirements.

"The governor supports reasonable work promotion and opportunities," he said. "In the end, the question is what policy works for Louisiana and becomes an enrichment and engagement opportunity for people."

President Donald Trump's administration has encouraged states to seek federal approval to require Medicaid recipients to work, but it's allowing states to tailor the proposals to the needs of their Medicaid populations.

In a letter to state Medicaid directors, Center for Medicaid and CHIP Services director Brian Neale wrote, the federal Centers for Medicare & Medicaid Services (CMS) "recognizes that a broad range of social, economic and behavioral factors can have a major impact on an individual's health and wellness, and a growing body of evidence suggests that targeting certain health determinants, including productive work and community engagement, may improve health outcomes."

Eight states currently have work requirement requests pending with the federal government, while two states -- Kentucky and Indiana -- have received approval.

About 1.6 million people are on Medicaid in Louisiana, including nearly 465,000 people who have been added to the rolls since July 2016, when the state expanded its Medicaid program through the federal Affordable Care Act to cover some previously ineligible adults, mostly the working poor.

The state estimates that 65 percent to 75 percent of the current adult Medicaid recipients are already working, due to the earned income they report. Another 20 percent or so would fit into the exempted categories, such as pregnant women, the elderly, family caretakers and people with disabilities.

That leaves about 10 percent of the adult Medicaid population who are able bodied and eligible to work, LDH estimates.

"Those are the folks we would want to find and devise a policy to create an opportunity to promote work and engagement," Tuozzolo said.

LDH is also factoring for the possible overhead for enforcing the requirement.

"We don't want to create something that is really laborious or costly," Tuozzolo said. "It's an easy thing to talk about it, it's more complicated to adequately administer."

Before the special session was called, House GOP Caucus Chair Lance Harris had already drafted legislation for the regular session to establish a Medicaid work requirement.

Harris, R-Alexandria, couldn't be reached for comment on Friday.

As the majority leader in the House, it's likely his bill will resemble legislation proposed in the special session.

Harris' proposed legislation would require people 19 to 64 years old who are not disabled to work at least 20 hours a week or take part in a community engagement activity, such as volunteering or worker training, to receive Medicaid benefits.

It would not apply to pregnant women, people certified as being physically or mentally unfit for employment, or people who are responsible for taking care of children young than a year old, children with disabilities or children with serious medical conditions. It also would not apply to people who are enrolled in drug or alcohol addiction treatment programs.

Advocates for the poor and for working families generally oppose the idea, calling it overly onerous on recipients with little impact elsewhere.

Robin Rudowitz, a Medicaid expert at the nonpartisan Kaiser Family Foundation, said forcing Medicaid recipients to regularly submit documentation to prove that they are meeting the requirements or can justify why they aren't doesn't just root out those who aren't. It can have a negative impact on those complying with the rules, she said, because it takes valuable time from the working poor.

"These new policies are recasting Medicaid more in line with welfare program rules," Rudowitz said.

It's likely that there will be little positive impact on Louisiana's enrollment figures or bottom line, she added.

"States see limited savings and increased administrative costs," Rudowitz said.

Tuozzolo said Louisiana's treating the issue as a workforce issue.

"The approach we are focused on is we want the most healthy, productive workforce we can have in Louisiana," Tuozzolo said. "We need something that works for us."

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