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Medicaid Work Requirements Gain Momentum in the Midwest and South

Last Friday, Governor Rick Snyder (R) signed legislation that will make Michigan the most recent state to approve work requirements for Medicaid recipients. The new law, expected to be approved quickly by the Centers for Medicare and Medicaid Services (CMS), would require “able-bodied” Michiganders to work at least 80 hours a month or lose their health coverage. Work requirement laws in state Medicaid programs, newly approved by the Trump Administration starting in January of this year, are some of Republicans’ most blatant, and most contested, strategies to undermine health care for low-income Americans.

The Healthy Michigan Plan, the state’s Medicaid expansion program that was enacted in 2014 under the Affordable Care Act (ACA), currently provides health insurance for more than 670,000 people. Of these, nearly 73% would already be exempt from the proposed work requirements, being already employed (48.8%), qualifying as “disabled” (11.3%), or being retired, a caretaker, or a student (12.2%). The portion of the Medicaid expansion population in Michigan that would have work requirements imposed on them is about 185,000 people.

According to a new study from the University of Michigan in partnership with the Michigan Department of Health and Human Services, many of those 185,500 face significant health issues that, while not meeting the “formal criteria for disability,” bars them from participating in the formal workforce. 74% of those surveyed who were out of work – the categorization most likely to be targeted by the work requirements – reported having a chronic health condition. Of the same group, 24% told the researchers that they were unable to maintain normal day-to-day functions more than 14 days in the last month due to physical impairments, and 25% reported the same as a result of mental health conditions. These new data undermine the Trump Administration’s notion that “productive work and community engagement...may improve health outcomes;” if people are not healthy enough to work to begin with, forcing work upon them certainly is not going to make them healthier.

Under the law set to begin in January 2020, 5-10% of Medicaid expansion enrollees in Michigan are expected to lose coverage. From those 27,000-54,000 people without health insurance, the state of Michigan may save anywhere from $5 to $20 million dollars. However, the Michigan Senate Fiscal Agency estimates $20-30 million in administrative costs to implement the new work requirements reporting. Despite the plan’s stated intent, the end result of Michigan’s work requirement program will not be helping Medicaid recipients to lead healthier lives or saving taxpayer dollars, but needlessly decreasing access to health care for low-income Michigan residents.

As Michigan’s law passes, a federal judge is set to rule any day on a similar measure which would institute work requirements for Medicaid recipients in Kentucky. Kentucky was the first state granted a work-requirements waiver from the administration, which, as opposed to Michigan’s proposal, applies to most adults receiving benefits and not just the expansion population. The law has been under court scrutiny since just a few weeks after passage when 15 Kentuckians who have health insurance through the state’s Medicaid expansion plan filed a lawsuit against the state, CMS, and the Department of Health and Human Services.

Governor Matt Bevin has threatened that he will end Kentucky’s expansion if the court does not allow the Section 1115 waiver, including the work requirements provision, to be implemented by its original July 1, 2018 start date. His ultimatum particularly stings when Kentucky is compared with its Southern neighbor states: Kentucky was one of only four Southern states to expand Medicaid; the region has 90% of the nation’s “coverage gap” population as a result. Without Medicaid expansion, it is estimated that 95,000 Kentuckians would lose health coverage and rejoin this group. Further, Medicaid expansion under the ACA has seen one of its greatest success stories in Kentucky: the state’s uninsured rate fell from 16.3% to 7.2% in just three years, and the program now covers over almost 500,000 new enrollees.

Medicaid protection and expansion is vital to HIV care in America: the program covers more than 40% of people living with HIV who are in care; it is also the single largest source of coverage in the US. It is widely understood that people in financially unstable situations are at higher risk for contracting HIV. As such, Medicaid, a program created to support low-income Americans access quality health care, must have no other eligibility strings attached if we are serious about ending the HIV epidemic.

For the health and wellbeing of people living with and at risk for HIV, AIDS United stands firmly against work requirements as a part of Medicaid. Check back to the AU Policy Update regularly for the latest info on the programs, funding, and legislation that support people living with HIV.

Posted By: AIDS United, Policy Department - Friday, June 29, 2018

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