State may add Medicaid work mandate

April 21--TRAVERSE CITY -- Requiring able-bodied Medicaid recipients to work could have an impact on northern Michiganders who rely on the government program for health care coverage.

But providers are still trying to determine how many of their patients could be affected. Michigan state senators on Thursday passed a bill that would add the requirements for any Medicaid recipient physically able to work to put in 29 hours a week and certify monthly to show they're meeting the requirement.

Medicaid recipients could also qualify by attending job training, working at an unpaid internship or tribal employment program, or participating in addiction treatment, according to a bill summary.

There are also several exemptions: The requirements are for anyone age 18-64, unless they're pregnant, caring for someone younger than 6, getting long-term disability benefits, going to school full time, living in a county with 8 percent unemployment or higher, collecting unemployment benefits and more.

A Senate fiscal analysis estimates the exemptions could mean that up to half of Michigan's 1 million traditional and expanded Medicaid -- called the Healthy Michigan Plan -- recipients don't have to meet the requirements, depending on how they're implemented.

Traverse City resident Besty Zeeyrt is covered by Medicaid, and said she had heard about possible work requirements. She breathed a sigh of relief upon learning she would probably be exempt.

"Oh thank God, because there's just no way I'd be able to do that, not with my mental health and my seizure disorder," she said.

Zeeyrt worries how the requirements could impact others with "invisible disabilities" like hers that keep them from working. She has bipolar disorder and generalized seizure disorder, and gets Supplemental Security Income. She's seen how others struggle to meet the requirements for Medicaid or disability benefits, and a work requirement for Medicaid seems like "punishing somebody who's already down on the ground."

Medicaid covers around one in four northern Michiganders, Munson Healthcare Director of Government Relations Gabe Schneider said. That concentration can be even higher among certain patient groups in specific locales -- 70 percent of women and children in the Grayling area, for example.

Munson Healthcare and the Michigan Hospital Association are against the work requirements proposal as it stands, Schneider said. It could cause patients to lose their coverage, impacting their treatment outcomes.

"We know that better health outcomes come from having insurance coverage because people get treated for illnesses before they become acute," he said.

What's more, the bill doesn't seem to account for seasonal employees or volunteers, Schneider said. It's also unclear how much the requirements would cost to implement and manage -- Schneider added he's looking forward to state representatives on the House's proposal.

Traverse Health Clinic, a community health center in Traverse City, accepts Medicaid patients among others who may otherwise not have access to care, clinic CEO Arlene Brennan said. Nine percent of the clinic's patients overall, including those on Medicaid, were unemployed in 2015 and 8 percent were disabled.

Community health centers treated 208,050 Medicaid recipients statewide that year, Brennan said. Four percent of them were able-bodied and unemployed.

"So it's not a huge number that's out there," she said.

Brennan said she believes that most people who are unable to work will find an exemption. She's waiting to hear more from the Michigan Department of Health and Human Services, which manages the state Medicaid program, to get a better idea of the work requirements' impact. But she agreed it's not likely the current proposal would strip lots of Medicaid recipients of their coverage.

Bob Wheaton, an MDHHS spokesman, said in an email department employees are still reviewing the legislation's potential effects.

Traverse Health Clinic employees see firsthand how good health helps keep people in work. She credited the Healthy Michigan Program, which allowed people with incomes higher than the typical Medicaid cutoff to sign up, with helping put more people back on the job.

"I think that the biggest thing that we see is the vast majority of people who are able to, want to work, and we totally understand how important health care is to being able to go to work," she said.

State Rep. Larry Inman, R-Williamsburg, said he's sympathetic to the bill's overall premise. Those getting state aid should be working and contributing to society, if they can. But he'll give the bill a close read soon. He wants to find out if the proposal would harm Medicaid recipients who are legitimately unable to work.

"I need to find out what requirements they are talking about and if they are reasonable, and if they are not reasonable, I'm not going to vote for it," he said.

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