Ten­nessee seeks OK from feds for Ten­nCare work re­quire­ments

Chattanooga Times Free Press - - OBITUARIES - BY JONATHAN MATTISE

NASHVILLE — Ten­nessee is ask­ing Pres­i­dent Don­ald Trump’s ad­min­is­tra­tion to join the ranks of states re­quir­ing able-bod­ied, low-in­come adults to work, vol­un­teer or take classes in or­der to keep their gov­ern­ment-funded health care.

At the di­rec­tion of the GOP-led state Leg­is­la­ture, Ten­nessee has re­quested fed­eral ap­proval to im­pose the re­quire­ment on about 56,000 low-in­come adults if they want to keep their Med­i­caid health cov­er­age that is of­fered un­der the Ten­nCare pro­gram.

In a Dec. 28 ap­pli­ca­tion posted on­line by Med­i­caid this week, state health of­fi­cials gave their most de­tailed out­line to date about how they would im­ple­ment work re­quire­ments. The re­quire­ment would not ap­ply to the el­derly or dis­abled, or preg­nant women.

The state is fol­low­ing Trump’s call to wean poor peo­ple from gov­ern­ment ben­e­fits, but crit­ics say the work re­quire­ment could un­der­mine crit­i­cal ac­cess to health care and cost much more than it would save.

Ten­nCare’s plan would re­quire that, for at least four months out of six-month pe­ri­ods, ben­e­fi­cia­ries must log 20 hours weekly on av­er­age of qual­i­fy­ing work, com­mu­nity ser­vice, or ed­u­ca­tion. Vi­o­la­tors would face sus­pen­sion un­til they show they have com­plied for a month, though Ten­nCare may of­fer ways to re­gain cov­er­age be­fore that.

A num­ber of groups would be ex­empted, in­clud­ing one pri­mary care­giver per house­hold with a child younger than 6, those on short- or long-term dis­abil­ity or with cer­tain acute med­i­cal con­di­tions, care­givers for the dis­abled or med­i­cally frail, peo­ple re­ceiv­ing un­em­ploy­ment ben­e­fits, and oth­ers. Other cir­cum­stances could war­rant a “good cause” ex­emp­tion.

The state would count work re­quired un­der other pub­lic as­sis­tance pro­grams, and also would leave the op­tion open to loosen or re­move the re­quire­ment in eco­nom­i­cally dis­tressed coun­ties.

Trump has come up short in his ef­forts to re­peal for­mer Pres­i­dent Barack Obama’s Af­ford­able Care Act, which in­cludes Med­i­caid ex­pan­sion in states. Cen­ters for Medi­care & Med­i­caid Ser­vices ad­min­is­tra­tor Seema Verma is en­cour­ag­ing states to set work re­quire­ments for Med­i­caid, con­tend­ing that will en­cour­age peo­ple to earn their way out of poverty and de­pen­dence on gov­ern­ment in­sur­ance.

Arkansas of­fi­cials say nearly 17,000 peo­ple have lost Med­i­caid cov­er­age through Novem­ber since it be­came the first state to im­ple­ment the re­quire­ments in June. That ini­tia­tive is be­ing chal­lenged in fed­eral court. In Ken­tucky, a fed­eral judge blocked work re­quire­ments in June, but the state has since got­ten the Trump ad­min­is­tra­tion’s ap­proval for new rules that could be­gin to be phased in by April. Both of those states ex­panded Med­i­caid el­i­gi­bil­ity un­der the Af­ford­able Care Act.

How­ever, in Ten­nessee, GOP law­mak­ers have re­jected ef­forts to add about 300,000 peo­ple to the Ten­nCare rolls. About 1.3 mil­lion peo­ple have Ten­nCare cov­er­age, pri­mar­ily low-in­come preg­nant women, chil­dren up to age 21, the el­derly and the dis­abled. About 56,000 would be af­fected by work re­quire­ments, Ten­nCare es­ti­mates.

Craig Becker, the Ten­nessee Hos­pi­tal As­so­ci­a­tion’s pres­i­dent, said the work re­quire­ment is an “an odd fit” for Ten­nessee be­cause, after re­fus­ing to ex­pand its Med­i­caid rolls, the state only has a lim­ited num­ber of able-bod­ied adults who would qual­ify. Any po­ten­tial sav­ings would not make up for the tens of mil­lions of dol­lars in pro­jected costs for case man­age­ment and link­ing ben­e­fi­cia­ries to train­ing and sup­port, in­clud­ing child care and trans­porta­tion, he wrote.

“Im­ple­ment­ing the work re­quire­ment and com­mu­nity en­gage­ment pro­gram de­scribed in this amend­ment is pre­ma­ture and should not be con­sid­ered un­til the pro­gram has added cov­er­age for adults with­out de­pen­dent chil­dren or fam­ily mem­bers, a group for which the work and com­mu­nity en­gage­ment re­quire­ments may be more ap­pli­ca­ble,” Becker said.

The state coun­ters that it could cover the costs us­ing Tem­po­rary As­sis­tance for Needy Fam­i­lies money, a move that needs fed­eral ap­proval.

Many health groups — from can­cer to men­tal ill­ness ad­vo­cates — also wor­ried about how the state will de­fine “med­i­cally frail,” though the state said it will de­velop def­i­ni­tions con­sis­tent with fed­eral re­quire­ments.

Other con­cerns were raised about how ben­e­fi­cia­ries would re­port their hours, cit­ing a lack of In­ter­net ac­cess for some on Ten­nCare.

The Amer­i­can Can­cer So­ci­ety is among the groups wor­ried about bu­reau­cracy, say­ing a “bur­den­some doc­u­men­ta­tion process” could mean some peo­ple are locked out of cov­er­age or dis-en­rolled, “jeop­ar­diz­ing ac­cess to life-sav­ing treat­ment.”

The state said it’s still mulling ex­actly how ben­e­fi­cia­ries will doc­u­ment hours and re­ceive ex­emp­tions, say­ing it needs to “strike a bal­ance” be­tween en­sur­ing ac­cu­racy and min­i­miz­ing ad­min­is­tra­tive bur­den on Ten­nCare re­cip­i­ents.

“Im­ple­ment­ing the work re­quire­ment and com­mu­nity en­gage­ment pro­gram de­scribed in this amend­ment is pre­ma­ture and should not be con­sid­ered un­til the pro­gram has added cov­er­age for adults with­out de­pen­dent chil­dren or fam­ily mem­bers, a group for which the work and com­mu­nity en­gage­ment re­quire­ments may be more ap­pli­ca­ble.”

— CRAIG BECKER, THE TEN­NESSEE HOS­PI­TAL AS­SO­CI­A­TION’S PRES­I­DENT

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