The federal Centers for Medicare and Medicaid Services has announced it will support state policies that require people to work for their Medicaid coverage. Ten states —including Indiana and Kentucky — have submitted proposals to add a so-called work requirement to their Medicaid plans.
States are still awaiting formal approval of their requests. But the long-anticipated CMS announcement — made clear in a letter to states released early Thursday — is a bad sign for some health care advocates, who worry that people will lose coverage because of the additional administrative burden of the requirement.
“Somewhere along the way paperwork gets lost, there’s a miscommunication,” said Adam Mueller, who heads up advocacy efforts for Indiana Legal Services, a nonprofit that helps people navigate Indiana’s Medicaid.
CMS said in the letter the new guidance allows states to experiment with the idea of work requirements (or related activities such as skills training, education, job search, caregiving, volunteer service) “in order to determine whether those requirements assist beneficiaries in obtaining sustainable employment.”
“We owe beneficiaries more than a #Medicaid card,” tweeted CMS Administrator Seema Verma Thursday. “We owe them the opportunity and resources to connect with job skills, training and employment so they can rise out of poverty.”
— CMS Administrator (@SeemaCMS) January 11, 2018
Traditionally, Medicaid covered people not able to work — the elderly, children and the disabled. During the Obama Administration, 32 states expanded their Medicaid programs to include low-income adults, making health insurance available to poor working people.
Under the proposed work requirement, people will have to prove that they’re working or performing some other qualifying activity such as volunteering. Or that they’re exempt. And that could be difficult, said Mueller.
“Folks have sometimes had difficulty proving something as easy as residency,” he said. Additionally, “there are a lot of things that can trip folks up, and that could lead to falling through the cracks.”
And people in Medicaid are often dealing with crises – they may move a lot, or change phone numbers, making them difficult to track down.
Dr. Phyllis Platt, CEO of Shawnee Christian Healthcare Center in Louisville, is concerned for her patients.
Platt said the area where the center is located has limited job opportunities.
“For us for example, we’re in an urban area, but in a neighborhood where there are very limited jobs. So the potential for work in our neighborhood without having to take a bus significant distance and time out of the neighborhood is going to be a challenge,” she said.
Platt also is concerned about patients who’ve been incarcerated.
“And then we find that that will be a challenge for some of our justice-involved patients, folks who are transitioning out of incarceration,” said Platt. “’Well, I’m a felon so who’s going to hire me to be either a volunteer or the difficulty that felons have already with finding employment?’”
Additionally, there’s not consensus the programs are effective at getting people into jobs, said Joan Alker of Georgetown University during a conversation in Lexington, Kentucky in November.
“Everybody wants to increase employment, that’s a great goal, but this is not the right way to go about that,” said Alker. “We know from studies that this kind of requirement doesn’t work; it doesn’t help people get jobs. We want people to be healthy so they can work, and if we take away their health coverage they’re going to get sicker and not going to be able to work.”
According to the nonprofit Kaiser Family Foundation, the majority of Medicaid enrollees are still “traditional” Medicaid recipients, likely unable to work. Of the share of “able-bodied” adults (on Medicaid but not receiving Supplemental Security Income), six in ten are working themselves and eight in ten are in a family with one working member — meaning other members may need to stay home due to caregiving responsibilities.
The federal government is expected to approve Kentucky’s work requirement proposal Friday and Indiana’s sometime this month.
This story was produced by Side Effects Public Media, a reporting collaborative focused on public health.