Tuesday, 25 September, 2018

Job requirements for Medicaid recipients won't work and might actually backfire

President Donald Trump and Kentucky Gov. Matt Bevin Job requirements for Medicaid recipients won't work and might actually backfire
Nellie Chapman | 19 January, 2018, 01:32

Trump administration officials, like their Kentucky counterparts, know this. "The pain is the point" of the policy, columnist and economist Paul Krugman wrote.

Let's start with the facts.

Any work requirements would only apply to "able-bodied" adults, with exemptions for children, the elderly and people with disabilities.

Furthermore, the administration is not forcing this policy on the states.

The U.S. Centers for Medicare and Medicaid Services has to agree to enact such work requirements. Currently, 10 states have done this.

The Kentucky Health program is a relatively new approach to Medicaid reform and will test the impact of Medicaid work requirements, which can be a hot-button political issue.

Kentucky's proposal is likely to prompt legal challenges.

Kentucky is one of at least 10 states interested in the waiver with Arizona, Arkansas, Indiana, Kansas, Maine, Mississippi, New Hampshire, Utah, and Wisconsin all citing interest in the work requirement.

The Kaiser Family Foundation found that 78 percent of Medicaid beneficiaries nationally are now working and that work requirements may just add unnecessary barriers for individuals seeking Medicaid coverage and benefits.

The approval comes days after CMS announced it will support community engagement incentives within 1115 demonstrations including the use of individual work requirements.

If these conditions don't sound draconian, that's because they aren't. This means states can now require adults on Medicaid to get a job, go to school, take a job-training course or perform community service to continue their eligibility.

Many people may not be able to work a full-time job, but they can work part time or they can help volunteer two to four hours a week, which can help give people a chance to get out of the house and socialize. Kentucky-which just a few years ago made headlines as an Obamacare "success story," launching its own health insurance exchange and expanding Medicaid to more than 400,000 low-income residents-has seen a sharp reversal since electing a Tea Party governor in 2015. In 2018, more states will put Medicaid expansion on the ballot, as citizens across the country go on the offense to improve their quality of life. According to the Kaiser Family Foundation, about 25 million Medicaid beneficiaries are covered due to the ACA's expansion. But the state's share is poised to grow and Bevin, a Republican who took office after the expansion, says Kentucky can't afford to maintain it without changes. Traditional opposition to Medicaid work requirements therefore needs to be re-examined.

The Kentucky initiative also eliminates a transportation benefit, created to get poor people to the doctor or hospital when they don't have the means to do so. He will be re-enrolled in Medicaid, or the cost of his treatment will be absorbed in some other way. But Sara Rosenbaum, a professor of health law and policy at George Washington University, says there's a problem with that - most people on Medicaid are already working, or looking for work. For example, a state might set its goal as having 70 percent of targeted beneficiaries working, rather than all targeted beneficiaries. Ten states already have asked the federal government for the waiver needed to move forward with the measure that - if not by design, then by effect - punishes poor people. These are the same arguments that advocates for the poor are likely to make if and when they sue to block the changes. Still others have tried to find work but can't. It also helps finance the operation of safety net hospitals.

― a key if underappreciated provision of Medicaid in most states ― doesn't simply help low-income people avoid crippling medical debt. Instead, they reflect proper social expectations.