States Can Request Work Requirements For Medicaid

Jan. 30--For states wanting to attach a work requirement to able-bodied Medicaid recipients, the gate is now open.

A letter from the Center for Medicaid and CHIP Services sent to state Medicaid directors on Jan. 11 allows states to refuse Medicaid benefits unless they have a job, are in school, volunteer, serve as a caregiver, or take part in some sort of "community engagement."

Nine states -- Maine, New Hampshire, Wisconsin, Indiana, North Carolina, Arkansas, Kansas, Utah and Arizona -- seek a thumbs-up from the federal government for Medicaid work requirements. Kentucky has already received permission, and a lawsuit has been filed.

Seema Verma, administrator for CMS, told reporters on Jan. 11 that a reduction in number of Medicaid enrollees would be interpreted as fewer people needing the benefits.

"We see people moving off of Medicaid as a good outcome," Verman said.

While work requirements and time limits have been attached to Temporary Assistance for Needy Families and the Supplemental Nutrition Assistance Program, the idea that health care is "a right" has resulted in less government momentum to attach requirements to Medicaid.

Justin Kennedy, chair of the Cherokee County Young Republicans, called the idea of a right to health care "a common misconception."

"You have no right to another person's services," Kennedy said. "I do believe you have the right to choose your health care -- that it shouldn't be forced or mandated or require you to visit a certain hospital -- but you are not entitled to anybody else's service. You don't have the right to go to a doctor's home for medical service, and he being forced to provide it under threat of government retaliation."

A number of Democrats spoke against the new policy, and critics charge that the work requirement is one of the Trump administration's tactics to hollow out funding for Medicaid, and that low-income families will not have health insurance.

However, a 2017 Kaiser Family Foundation poll suggests 70 percent of Americans -- including 56 percent of Democrats -- are OK with states applying Medicaid work requirements adults without disabilities. Other polls have recorded similar sentiments.

"I think it is a great idea," Kennedy said. "When we talk about Medicaid, we think of the most vulnerable in our society. This would be about able-bodied adults who meet the minimum requirements for Medicaid, and qualified because they are not working. I see no reason why we shouldn't expect them to be engaged in some sort of work. There are no requirements for those with disabilities, or who are aged, pregnant women, caretakers, volunteers."

Kaiser president and CEO Drew Altman wrote in 2017 that only about 10 percent of Medicaid recipients could have their aid affected in states that adopt the federal guidelines, and most of those are seeking jobs, which is an exemption that allows continued benefits.

"We are probably talking about a minority of beneficiaries being impacted, probably mostly the single males that gained access under expansions under President Obama," said Dr. Shannon Grimes, chair of the Cherokee County Libertarian Party. "About two-thirds of this money goes to cover the sick and elderly in nursing homes and similar facilities. The next biggest chunk is single mothers. There doesn't appear to be a giant number of able-bodied people simply taking advantage of the system."

Grimes said Medicaid helps many who are vulnerable, but also thinks those who can work should try to find employment.

"I haven't seen a good argument against the government trying to create positive incentives as a qualifier to receive money from the program," Grimes said. "I doubt anyone is planning on making our disabled grandparents get a job to keep getting their Medicaid benefits."

The federal guidelines only specify exemptions for pregnant women and people who are "medically frail." They don't expound on what "frail" means. Drug treatment can count toward work requirements. People on SNAP and TANF already meet Medicaid requirements.

Otherwise, there is some leeway on what states can demand.

The Kentucky Equal Justice Center noted that under the state's work requirement, Medicaid recipients must report income changes within 10 days, which might be difficult for someone who counts tips as pay.

Current Medicaid enrollment in the U.S. numbers more than 68 million.

A Tahlequah Daily Press online poll on Medicare work requirements drew few responses. The question was, "With some exceptions (volunteering, disabled, elderly, a caregiver, etc.), should a person have to work to have Medicaid health care benefits?" Among readers who responded, two absolutely agreed, three somewhat agreed, two somewhat disagreed and two absolutely disagreed.

In the Jan. 20 TDP Saturday Forum, readers were also asked to post about the new policy. However, the discussion revolved around the U.S. health care system in general.

S.C. Tuttle outlined bad experiences with U.S. health care, recalling his inability to work for a number of years, and faulting the doctors more than the injury.

"It goes back to if an able body can work, then it should; if it can't, then it can't," Tuttle said. "I don't believe the majority of people choose to have a body that is not able to work."

Gary Stopp supported work requirements for Medicaid.

"...you should contribute time, work, volunteer, etc," Stopp wrote. "Why should anybody get anything for nothing? How does that make any sense? If you do drugs, you get cut off."

Requests for comment from Debra Proctor, chair of the Cherokee County Demoratic Party, and Kari Barnes, chair of the Cherokee County Republican Party, were not returned by press time.

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