Ohio’s Medicaid work rules still pending
State says 36,000 will lose eligibility; critics expect more.
It’s been seven months since the state asked the federal government for permission to impose work requirements on those receiving Medicaid. Those in Ohio familiar with the process say the Centers for Medicare and Medicaid Services (CMS) is approving waivers based on the order they were received, meaning Ohio’s turn should be soon.
“The Trump Administration has continued to approve work and community engagement waivers in more states,” said Rea Hederman, executive director of the Economic Research Center and vice president of policy at The Buckeye Institute, a right-leaning think tank. “This is an administration that is willing to work with states on these Medicaid reforms, and that bodes well for Ohio’s waiver being eventually approved.”
So far, CMS has approved five of the 14 waivers that would, among other things, establish minimums on the number of hours needed to be worked to be eligible for Medicaid. CMS has approved waivers in Arkansas, Indiana, New Hampshire, Wisconsin and, most recently, Kentucky.
Ohio’s waiver requires most able-bodied adults to work or participate in a sanctioned community engagement activity, like Supplemental Nutrition Assistance Program (SNAP) education and training activities, for 80 hours monthly to be eligible for Medicaid. The work requirement includes exemptions for people with severe disabilities, pregnant women, parents, caretakers and Ohio Works First recipients of cash assistance, as well as able-bodied adults living in counties with high unemployment rates.
The state submitted its proposal to the federal government on April 30. The plan was expected to go into effect July 1 of this year but has yet to be approved.
A CMS spokesperson said that the agency does not comment on pending applications but is working with each state.
“While we cannot forecast a decision on components of a state’s application, we strive to review and process applications as quickly as possible,” the spokesperson said.
A requirement to force recipients to work highlights a debate between whether Medicaid should be a temporary welfare program for those facing stints of unemployment or a means to provide long-term healthcare coverage to the country’s most vulnerable. The waivers roll back some provisions of the Affordable Care Act, namely that the same number of people must be enrolled in healthcare plans, under which Medicaid was expanded in more than 30 states, including Ohio.
In January, the Centers for Medicare & Medicaid Services issued guidance to state Medicaid directors encouraging them to apply for waivers to establish work or community engagement requirements for Medicaid.
Wendy Patton, senior project director for Policy Matters Ohio, a left-leaning think tank, said the Trump administration’s healthcare policy changes are incremental blows to the ACA and to healthcare coverage.
“It’s being eroded from the inside, and the work requirements are part of that,” Patton said.
When the state implemented similar work requirements for SNAP, it estimated 134,000 people would lose eligibility. In reality, nearly 370,000 Ohioans were disenrolled, according to Loren Anthes, public policy fellow for The Center for Community Solutions.
After Arkansas instituted a Medicaid work requirement June 1, more than 4,000 people were disenrolled within the first three months for not complying with the new requirements.
In Ohio, the state estimates about 36,000 people will not be eligible for Medicaid under the work requirements. Critics say that number is too low.
State think tanks, medical associations and local officials oppose Ohio’s proposed Medicaid waiver, saying the work requirements would make healthcare less accessible, cost millions to implement and disproportionately affect black communities.
Because low-wage earners often have little control over their hours, remaining eligible could be a challenge for many Ohioans, putting them at risk for losing coverage, Patton explained. And that ignores the challenge of routinely proving eligibility, she said.
“This is very bad for health, and it will reverse the gains we’ve seen,” Patton said.
Ohio expanded Medicaid to cover an additional 700,000 Ohioans under the Obama administration, bringing the state Medicaid population to about 3 million.