States ex­plore con­se­quences of Med­i­caid work man­date

Honolulu Star-Advertiser - - NATION -

Repub­li­cans last week be­gan to re­al­ize their long-held goal of re­quir­ing cer­tain adults to work, get job train­ing or per­form com­mu­nity ser­vice in ex­change for get­ting health cov­er­age through Med­i­caid. Whether that’s a com­mon­sense ap­proach or an added bur­den that will end up cost­ing many Amer­i­cans their health in­sur­ance will now be de­bated in states across the coun­try con­sid­er­ing the land­mark change to the na­tion’s largest health in­sur­ance pro­gram. Repub­li­cans say work and other re­quire­ments will re­turn Med­i­caid to its orig­i­nal in­tent — a stop­gap un­til peo­ple can find work. They say it has ex­panded far be­yond its ba­sic mis­sion. The pro­gram, cre­ated in 1965 for fam­i­lies on wel­fare and low-in­come se­niors, now cov­ers more than 70 mil­lion peo­ple, or about 1 in 5 Amer­i­cans. It ex­panded un­der Pres­i­dent Barack Obama’s health care law, with a ma­jor­ity of states choos­ing to cover mil­lions more low-in­come peo­ple. Pres­i­dent Don­ald Trump’s ad­min­is­tra­tion an­nounced that it will al­low states to im­ple­ment cer­tain re­quire­ments as a con­di­tion of re­ceiv­ing Med­i­caid ben­e­fits. Gen­er­ally, states can re­quire many adults on Med­i­caid to get a job, go to school, take a job-train­ing course or per­form com­mu­nity ser­vice to con­tinue their el­i­gi­bil­ity. Ten states had pre­vi­ously asked the fed­eral gov­ern­ment for the re­quire­ment waiver, and oth­ers are sure to fol­low. On Fri­day, Ken­tucky be­came the first to have it ap­proved. Gov. Matt Bevin, a Repub­li­can, called the new re­quire­ment “trans­for­ma­tional.”

Bevin has said he ex­pects the move to save the state more than $300 mil­lion over the next five years in Med­i­caid costs. But he also es­ti­mated that as many as 95,000 Ken­tucky res­i­dents could lose their Med­i­caid ben­e­fits, ei­ther be­cause they will not com­ply with the new rules or will make too much money once they be­gin work­ing. Crit­ics of the pol­icy shift point to the num­ber of peo­ple who could lose cov­er­age, even if they meet the new re­quire­ments.

“We just have con­cerns that a lot of peo­ple who still are le­git­i­mately el­i­gi­ble, who do meet the work re­quire­ment, will end up fall­ing off the rolls be­cause they don’t know how to ver­ify or there’s a tech­nol­ogy glitch,” said Mar­quita Lit­tle, health pol­icy di­rec­tor for Arkansas Ad­vo­cates for Chil­dren and Fam­i­lies.

In Arkansas, the work re­quire­ment is among sev­eral new re­stric­tions the state has pro­posed for its hy­brid Med­i­caid ex­pan­sion. About 285,000 peo­ple are on the pro­gram, which uses money from Med­i­caid to buy pri­vate health in­sur­ance for low-in­come peo­ple. Sup­port­ers of the work re­quire­ment cast it as a way to move more peo­ple into the work­force and even­tu­ally off Med­i­caid.

“Th­ese are peo­ple that are ei­ther un­der­em­ployed or do not have suf­fi­cient train­ing, and this is a mech­a­nism to put into place to make sure that the health care cov­er­age is re­ally a bridge to train­ing and bet­ter em­ploy­ment,” Arkansas Gov. Asa Hutchin­son, a Repub­li­can, said.

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