Pennsylvania Republicans push controversial work requirements for Medicaid

July 11--Pennsylvania House Republicans approved a newly drafted proposal Tuesday to impose work requirements on people with Medicaid, raising objections from consumer groups who accused the bill's sponsors of acting quickly to avoid public scrutiny.

The legislation, House Bill 59, was originally written to improve adoption laws. House Republicans heavily amended the bill Monday to add the work requirement and make other changes to Medicaid they say will save the indebted state money, then voted along party lines Tuesday to approve it. The bill still requires approval from the Senate and the governor to pass.

"This is kind of done in the middle of the night, moving forward proposals that would impact hard-working Pennsylvanians that rely on Medicaid for coverage," said Antoinette Kraus, director of Philadelphia-based consumer group Pennsylvania Health Access Network.

The bill would also introduce monthly premiums for high-income families whose children qualify for Medicaid because of severe disabilities. It would keep people from switching insurance carriers more than once a year within Medicaid.

"We're trying to look at some common-sense approaches to contain costs yet still make sure that services are preserved for the most needy," said Stephen Miskin, spokesman for House Majority Leader Dave Reed, R-Indiana.

Miskin said the changes would help address a budget deficit projected to reach $2 billion for the fiscal year that started July 1. The Department of Human Services, which oversees Medicaid, is projected to spend the second-highest amount of money among state agencies for the year, according to state Independent Fiscal Office projections.

The bill directs the Department of Human Services to seek "reforms that require reasonable employment and job search requirements for those physically and mentally able."

Miskin said the idea of a work requirement is not new, having been discussed by legislators for years as part of other proposals. He said the proposal would promote self-sufficiency and save the state money over time.

States cannot impose work requirements in Medicaid without federal approval. The administration of former president Barack Obama denied state's requests to waive the law, according to an analysis by the Kaiser Family Foundation, a Washington-based health policy organization.

Miskin said a March letter from Trump administration officials to governors, in which the administration affirmed its support for job programs in Medicaid, spurred this week's legislative push.

A spokesman for Gov. Tom Wolf said the governor opposes the legislation.

"Seniors, people with disabilities and low-income working families don't need their lives to be made even more difficult by politicians in Harrisburg," spokesman J.J. Abbott said in a statement. "Beyond the substance of these changes, the process flies in the face of good government and these changes would cost millions of taxpayer dollars just to implement. There was no input from stakeholders or families that would be affected and no formal fiscal analysis. Medicaid is not a handout -- it is a lifeline. We need to support these families, not create more hoops for them to jump through."

Department of Human Services data show that 58 percent of Pennsylvanians who qualify for Medicaid through a state expansion of the program are employed. The expansion, implemented by Gov. Tom Wolf, made eligible any individual who makes up to about $16,000 per year. Among people who qualify under traditional guidelines ­-- which are tighter and take into account disabilities -- 51 percent are employed, according to the DHS data.

"A federal waiver (permitting a work requirement) solves nothing, while creating new problems" Community Legal Services of Philadelphia said in a statement.

Pennsylvanians with severely disabled children can qualify for Medicaid regardless of their income or insurance situation. For a family of four with a severely disabled child and an income of about $250,000, the proposal would institute a monthly premium of about $53 per month, Miskin said.

Kraus said she fears the proposal could lead to premiums and added costs for lower-income people with Medicaid.

"We worry this would open up the door to imposed premiums or increased cost-sharing on a population of folks who are already struggling in most cases to meet their daily obligation," she said.

The proposal would keep people from switching more than once a year among Medicaid insurers, known as managed care organizations. The change would make enrollment in the program more closely resemble private insurance, in which people can switch plans only during annual open enrollment periods.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676, wventeicher@tribweb.com or via Twitter @wesventeicher.

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