Med­i­caid work man­date may cre­ate un­cer­tainty


LIT­TLE ROCK, ARK. — Repub­li­cans this past 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.

To Med­i­caid re­cip­i­ents such as Thomas J. Penis­ter of Mil­wau­kee, it’s cre­ated un­cer­tainty about their abil­ity to have health cov­er­age.

He’s been un­em­ployed for the last four or five years and has re­ceived Med­i­caid for the past two. He sees a be­hav­ioral health spe­cial­ist to deal with anx­i­ety and said Med­i­caid has made a big dif­fer­ence in his life.

Penis­ter, 36, said he is not yet ready to re­join the work­force and is un­nerved by the prospect of po­ten­tially los­ing Med­i­caid. His state, Wis­con­sin, is one 10 that ap­plied to the fed­eral gov­ern­ment for a waiver seek­ing to im­ple­ment work and other re­quire­ments for sin­gle adults.

“Would it be ad­van­ta­geous for me even to go into the work­force in­stead of me ther­a­peu­ti­cally tran­si­tion­ing to a state where I’m ac­tu­ally ready to per­form in the work­force?” he said. He com­pared it to some­one re­cov­er­ing from a car ac­ci­dent “and say­ing that in or­der for me to give you this med­i­ca­tion, you got to go to work. Well, I can’t.”

Yet his story also helps make the case for those who fa­vor some type of com­mit­ment from work­ing-age adults who ben­e­fit from Med­i­caid, the statefed­eral health care pro­gram for poor and lower-in­come Amer­i­cans. Wis­con­sin Gov. Scott Walker, a Repub­li­can, sought fed­eral ap­proval for a work re­quire­ment last year and said it helps pre­pare re­cip­i­ents to leave pub­lic as­sis­tance.

Penis­ter’s sta­tus is un­clear, be­cause Wis­con­sin’s pro­posed changes would ex­empt any­one di­ag­nosed with a men­tal ill­ness or who is men­tally un­able to work.

Repub­li­cans say work and other re­quire­ments will re­turn Med­i­caid to its orig­i­nal in­tent — to act as 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, it will mean that 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 low­in­come peo­ple.

Sup­port­ers of the work re­quire­ment cast it as a way to move more peo­ple into the work­force and even­tu­ally off the pro­gram.

“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, told The As­so­ci­ated Press. “I think it really fits in with the goals of our state in in­creas­ing our work­force and train­ing our work­force.”

States face lim­its on how far they can go. The ad­min­is­tra­tion has said states should ex­empt preg­nant women, the dis­abled and the el­derly, and that they should take into ac­count hard­ships for peo­ple in ar­eas with high un­em­ploy­ment or for peo­ple car­ing for chil­dren or el­derly rel­a­tives. States also have to make ac­com­mo­da­tions for peo­ple in treat­ment for drug and al­co­hol prob­lems.

Arkansas’ waiver re­quest to the fed­eral gov­ern­ment says it would re­quire child­less, able­bod­ied adults on ex­panded Med­i­caid be­tween the ages of 19 and 49 to work 20 hours a week or par­tic­i­pate in other ac­tiv­i­ties such as job train­ing or vol­un­teer­ing.


Med­i­caid re­cip­i­ent Thomas J. Penis­ter, of Mil­wau­kee, re­sponds to a ques­tion dur­ing an in­ter­view Fri­day in Mil­wau­kee. Penis­ter does not fa­vor a work re­quire­ment in or­der to re­ceive Med­i­caid be­cause of the vary­ing cir­cum­stances of the in­di­vid­u­als re­ceiv­ing the health in­sur­ance.

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