Requirements disproportionately impact low-income and African American communities

WASHINGTON, D.C.-In a letter, Ohio's U.S. House Democratic Delegation urged Governor John Kasich to rescind employment and community engagement requirements for Medicaid beneficiaries. On February 16, 2018, the Ohio Department of Medicaid proposed a Group VIII Work Requirements and Community Engagement 1115 Demonstration Waiver. The letter was cosigned by Representatives Marcy Kaptur (OH-09), Tim Ryan (OH-13), Joyce Beatty (OH-03) and Marcia L. Fudge (OH-11).

"By pushing through a waiver that will have a detrimental impact to majority African American populations, this policy will exacerbate already existing economic and health disadvantages," the Members wrote. "This same disparate treatment - using counties, instead of cities as a baseline - is also present in Ohio's method for determining exemptions for work requirements in the Supplemental Nutrition Assistance Program (SNAP). In both cases, the result is unfair for beneficiaries in urban areas with high-unemployment."

"As any steward of taxpayer dollars, we want to retain Medicaid funds for all beneficiaries who truly need the program but this waiver would create needless administrative bureaucracy and red tape that will almost certainly end up accidentally kicking off men and women who truly need and deserve this program," the Members continued.

A full copy of the letter can be found below

May 24, 2018

Governor John Kasich

Riffe Center, 30th Floor

77 South High Street

Columbus, OH 43215-6117

Governor Kasich,

I write to you today to express my concerns regarding recent efforts by the State of Ohio to enforce employment and community engagement requirements for Medicaid beneficiaries. Your efforts to implement and expand Medicaid in Ohio allowed for more than 700,000 Ohioans to be enrolled in the program. Through this expansion we have seen great strides in our state for increasing access to quality, affordable healthcare. Your steadfast support of the program in the face of efforts by the Trump Administration and Congressional Republicans to repeal Medicaid, allowed many individuals to access much needed care, especially for those men and women receiving treatment, recovery and prevention for substance use through the program.

However, on February 16, 2018 the Ohio Department of Medicaid proposed a Group VIII Work Requirements and Community Engagement 1115 Demonstration Waiver that would severely impact communities that have a higher percentage of African Americans. The waiver states,

"Due to significant variations in the employment market across Ohio counties, Ohio will also align the Work and Community Engagement Requirement with SNAP policies that provide a waiver of the Able-Bodied Adults Without Dependents (ABAWD) time limit to certain counties (i) whose 24-month average unemployment rate was greater than 120% of the national unemployment rate during the same 24-month period based on unemployment data from the U.S. Bureau of Labor Statistics, or (ii) which do not have a sufficient number of jobs to provide employment for individuals."

By basing the exemption on entire counties--instead of cities with high unemployment within the county--the waiver is effectively discriminatory against low-income communities. Of the 26 counties that are exempted, on average 95 percent of the population is white. If this waiver is implemented, the State of Ohio owes every city the same requirements for enforcement. By pushing through a waiver that will have a detrimental impact to majority African-American populations, this policy will exacerbate already existing economic and health disadvantages. This same disparate treatment--using counties, instead of cities, as a baseline--is also present in Ohio's method for determining exemptions for work requirements in the Supplemental Nutrition Assistance Program (SNAP). In both cases, the result is unfair for beneficiaries in urban areas with high-unemployment, and I urge you to change how work requirements exemptions are determined if Ohio proceeds with its 1115 Demonstration Waiver.

There is a larger question, however, about the very rationale of the 1115 Demonstration Waiver. As any steward of taxpayer dollars, I want to retain Medicaid funds for all beneficiaries who truly need the program but this waiver would create needless administrative bureaucracy and red tape that will almost certainly end up accidently kicking off men and women who truly need and deserve this program. Studies have shown that the enforcement of these requirements and the case management services needed would cost Ohio taxpayers more than $378 million over the course of the waiver. These new requirements would, in fact, target a small fraction of the overall millions of beneficiaries properly using Medicaid. Thus, implementing this waiver risks spending more taxpayer money then it would save.

I urge you to reconsider these policies and instead support the idea that every American should have access to quality and affordable healthcare. Thank you for your attention to this matter.

Sincerely,

Marcy Kaptur

Tim Ryan

Joyce Beatty

Marcia L. Fudge

Read this original document at: https://beatty.house.gov/media-center/press-releases/ohio-house-democrats-urge-gov-kasich-to-rescind-harmful-medicaid-work