Medicaid work requirement doesn’t solve the problem

On June 1, Arkansas became the first state to implement a work requirement for Medicaid under a waiver program approved by the Trump administration agency, the Center for Medicare and Medicaid Services. Understanding what it does and what it does not do is important since three other states, Kentucky, Indiana and New Hampshire, have also applied and received approval and others are waiting in line.

Medicaid is health insurance. On first blush it can seem realistic to require “able bodied persons” to work to receive Medicaid benefits. In fact, a number of states instituted work requirements for other programs including EBT — otherwise referred to as food stamps. There are also work requirements for a Medicaid program known as Temporary Assistance for Needy Families (TANF) which as the name indicates, provides benefits for a limited period to mothers and children in needy families. Some of these rules have been suspended for portions of a state where unemployment is high.

One of the first things to know about Medicaid is that it is first and foremost a health insurance program. So the program “Arkansas Works” assumes that eliminating health insurance for large numbers of poor unemployed will incentivize them to seek and obtain employment. The state also points out that other alternatives can be used to satisfy the work requirement including job training or vocational classes.

When I first heard of the work requirement movement for Medicaid I admit I was confused. Who would it apply to? Obviously, it could not be required for elderly great-grandmothers in nursing homes. Otherwise Medicaid is available to SSI recipients, people who have been determined to be disabled who are very low income after receiving approval for their disability from the Social Security Administration.

The maximum cash benefit for SSI recipients is $750 per month nationally and states may weigh in with some additional. Pennsylvania has had a figure of $22.10. The primary benefit for being disabled under SSI is Medicaid for health insurance. Disabled children may qualify for Medicaid health insurance and mothers under the previously described TANF program which, as indicated, often requires work anyway.

Reading further I realized that Arkansas and other states are taking aim at individuals who received health insurance as the result of Medicaid expansion under Obamacare. Medicaid expansion in Arkansas cut Arkansas’s uninsured rate in half. It applies in that state to people with incomes up to 138 percent of the federal poverty level. Arkansas wanted it lowered to be equal with the federal poverty level.

The assumption is able bodied and unemployed until proven otherwise. The Arkansas work requirement is 80 hours

per month and must be proven by filing reports. If a person fails to demonstrate he or she has met the 80 hour per month requirement for a period of 3 months, that person loses health insurance coverage for the entire calendar year. So continued eligibility for health insurance requires continued reporting throughout the year.

Reporting must be done exclusively online through the Arkansas Department of Human Services’ online portal. No reporting of compliance with the work requirement will be permitted in person, by phone or by mail. All reporting must be done online. By June 5, 27,140 low income adults ages 30 to 49 who now participate in the Medicaid expansion program must either report they completed 80 hours of work or community engagement activities during

the previous month or that they qualify for an exemption. By September 5, the number who must report is 93,471 and starting in 2019 all Medicaid expansion beneficiaries from ages 19 to 49 will have to report or lose health insurance.

It might be noted that people with incomes no higher than slightly above the federal poverty level might not have access to computers to report their work history. Also, when tens of thousands and more all need to report at

the same time to a single online portal the possibility that the online source might be overwhelmed could be considered. There is even another likely possibility which is that people who are affected might not hear about the requirement at all. The likelihood has been discussed that many low income individuals do not have Internet access, a cell phone, personal transportation or even stable housing.

Arkansas is allocating a total of $1.1 million in new

funding for administering the work requirement program and administration is to be handled by a department that already handles work requirements for food stamps and TANF.