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More States Jump on Medicaid Work Requirements Bandwagon

Feb 19, 2018 | February2018 |

Centers for Medicare and Medicaid Services Administrator Seema Verma, has signaled openness to approving work requirements for Medicaid. (Bill Clark/CQ Roll Call)

By Misty Williams RollCall.com

A growing number of mostly Republican-led states are rushing to follow Kentucky’s lead in requiring thousands of people on Medicaid to work or lose health coverage.

The governors of South Dakota, Alabama, Louisiana and South Carolina have said in recent weeks that they plan to pursue work requirements for their Medicaid programs, following the Trump administration’s release of guidelines for the concept in January.

“Whenever possible, we should always endeavor to help South Carolinians in need find their path to gainful employment and away from temporary assistance of government,” South Carolina GOP Gov. Henry McMaster tweeted Jan. 11, the same day federal officials announced the new guidance.

At least four non-expansion states, including Mississippi and Kansas, have already submitted formal work requirement proposals to the Department of Health and Human Services. They are among at least 10 states, including Indiana and Arkansas, to do so. The administration has only approved one proposal so far – in Kentucky, a state that expanded the government insurance program for the poor under the health law.

While proponents say work requirements are largely aimed at so-called “able-bodied” adults who gained coverage through Medicaid expansion, many of the states exploring the idea have not expanded the program under the 2010 health care law. And consumer advocates warn that puts at risk not just adults without kids but also poor parents, people with disabilities and children covered by traditional Medicaid.

Thirty-two states and the District of Columbia opted to broaden Medicaid under the law, extending coverage to millions of Americans — most of them adults without children with income of up to 138 percent of the federal poverty level. That’s roughly $16,800 for a single person in 2018.

Many of the non-expansion states considering work requirements already have some of the most stringent Medicaid eligibility requirements in the country. In Alabama, adults without children are barred from the program altogether; meanwhile, parents can only qualify if they earn no more than 18 percent of the federal poverty level, or less than $3,800 a year for a family of three, according to the nonpartisan Kaiser Family Foundation.

“These are parents living in the deepest poverty,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families. “Very vulnerable people will lose coverage, including parents, and I expect children to also be harmed by these policies.”

Children are more likely to have health insurance if their parents do, Alker said. Plus, one medical emergency can lead to bankruptcy for poor families, she said.

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