As states mull Medicaid work requirements, two scale theirs back

Sharing is caring!

Republicans nationwide received a clear message from President Donald Trump’s return to the White House about Medicaid: requiring enrollees to provide proof that they are employed, volunteering, or enrolled in school is once again a possibility.

Republican Governor Henry McMaster of South Carolina requested federal approval of a work requirement plan the day after Trump’s inauguration. Republican Governor Mike DeWine of Ohio intends to do the same shortly. In their attempt to cut billions from the federal budget, Republicans in Congress are examining Medicaid work requirements.

However, Georgia is proposing to reduce important aspects of the country’s only active program at a time when a second Trump administration is reigniting interest in work requirements. Additionally, Arkansas declared plans to resurrect a program that had been discontinued due to a court ruling in 2019 with significant modifications.

According to consumer advocates and health policy academics, the proposals from Georgia and Arkansas, the only two states that have enacted Medicaid work requirements, highlight the discrepancy between the rhetoric surrounding these programs and their actual operations.

According to Harvard professor Ben Sommers, a former health official in the Biden and Obama administrations, they acknowledge that their initial approach didn’t work. It ought to be a warning to federal policymakers: Don’t say, “Let’s do that,” pointing to Georgia and Arkansas.

During Trump’s first administration, Medicaid work requirement programs were approved in over a dozen states.

Georgia released a draft renewal plan for its Georgia Pathways to Coverage program in January following a costly and challenging implementation. The plan eliminates the need for monthly job documentation and premium payments. According to the state, those crucial components that proponents have said encourage work and individual accountability were never put into practice.

Upon initial application and annual renewal, enrollees would still need to fulfill the job requirement. Additionally, the proposed plan adds parents of children under the age of six to the list of individuals who can choose not to report to work. The plan is up for public comment until February 20.

Enrollees are not required to report their work hours, according to Arkansas’ most recent appeal to federal regulators. Rather, it suggests using data—such as income, employment history, educational attainment, whether a child resides at home, and other factors—to determine whether people are employed, providing care, or engaging in other qualifying activities, according to Gavin Lesnick, a spokesman for the state’s Medicaid agency.

According to the state’s proposal, those who are judged to be behind schedule in reaching their personal health and financial objectives will not be disenrolled; instead, they can continue to be covered by enrolling in a success coaching program. The Arkansas program is open for public comment until March 3.

According to KFF, over 90% of American individuals who qualify for Medicaid expansion are either employed or may not be subject to the program’s rules. Nevertheless, a number of states are acting swiftly to reinstate Medicaid work requirements.

Similar plans are being considered in South Dakota and Iowa in addition to the three states of South Carolina, Ohio, and Arkansas. They are being considered by Montana lawmakers who are debating whether to extend the state’s Medicaid expansion.

The Energy and Commerce Committee, which is in charge of Medicaid, the state-federal health insurance program for those with low incomes or impairments, would lose $880 billion in a budget proposal that House Republicans unveiled this week. Speaker Mike Johnson said that Republicans were debating Medicaid reforms that would impose work requirements prior to the publication of that plan.

Medicaid should only be available to those who are employed, according to proponents of such conditions.

In January, South Carolina Governor McMaster wrote to federal officials, “At the moment, it disincentivizes many low-income families from earning additional income because they would lose health coverage if they make too much money.” He has maintained that requiring work reporting is both economically sound and will encourage employment.

The requirements don’t help individuals get jobs, but health policy researchers warn that not having health insurance can prevent people from working. There is no proof that such programs improve people’s economic outcomes.

According to the state, Ohio’s plan aims to concentrate resources and efforts on people who are actively involved in their health decisions and independence.Most people are not required under the plan to submit forms, record activities on a regular basis, or do anything else beyond what is typically needed to enroll in Medicaid.Over 61,000 persons, or 8% of enrollees covered by the bill, would lose their Medicaid eligibility in the first year, according to Ohio’s calculations.

The reduction in recent work requirement ideas, according to researchers, health policy analysts, and consumer advocates, highlights the difficulties in requiring them for public services and may serve as a warning to Republicans in Washington, D.C., and nationwide. According to them, the schemes can decrease enrollment or remove people from Medicaid rolls while introducing expensive bureaucratic layers.

According to Leo Cuello, a researcher at the Georgetown Center for Children and Families, Medicaid’s work-reporting requirements are essentially faulty as a matter of health policy.

In 2018, Arkansas launched its first program before a federal judge declared it unlawful. The state had already extended Medicaid, in contrast to Georgia. More than 18,000 people lost coverage as a result of the work-reporting requirement, partly because participants were unclear or perplexed about how to disclose that they were employed.

Judge James Boasberg declared in his decision to terminate the program that its approval was arbitrary and capricious since it ignored one of Medicaid’s main objectives, which is to provide medical treatment to those in need.

By suspending, rather than canceling, health coverage for those who do not satisfy requirements through the end of the calendar year, Arkansas’ most recent proposal attempts to resolve a possible legal issue.

At a press conference presenting the new plan in late January, Arkansas Medicaid Director Janet Mann stated, “We have worked to design this amendment taking into account lessons learned from previous work requirements.”

However, Camille Richoux, health policy director of Arkansas Advocates for Children and Families, stated that the criteria are arbitrary and that there is no real distinction between suspension and termination.

It has the same effect: “You can’t visit the doctor,” she stated. Your prescriptions cannot be filled.

As 40 other states have done, Georgia’s Pathways program, which was introduced in 2023, has provided coverage to a small percentage of those who would be eligible for Medicaid if the state had completely expanded it to all low-income adults. According to the state, the suggested modifications will increase Pathways enrollment to up to 30,000 participants in the pilot’s last year. According to the state’s current estimates, a complete expansion would make at least 246,000 people eligible for Medicaid.

In a legislative hearing, Grant Thomas, the state’s deputy Medicaid commissioner, stated that as of late January, about 6,500 people had registered in Pathways. State authorities estimate that until December, the program had cost over $57 million in state and federal monies, with the majority of that amount going for program administration rather than payouts.

According to Russell Carlson, Commissioner of the Department of Community Health and head of the state’s Medicaid program, Pathways is fulfilling its purpose of expanding access to affordable health care coverage and reducing the state’s uninsured rate. He noted that the Pathways modifications are an effort to enhance the member experience while looking for methods to make government more effective and approachable.

Critics claimed that although Pathways compels participants to present evidence on a regular basis to demonstrate their employment, the program lacks effective job placement assistance. Individuals who may qualify for Pathways have reported that the entire procedure takes a lot of time because of the lengthy questionnaires, the website’s unfamiliar technical terminology, and a faulty mechanism for submitting papers.

According to Leah Chan, director of health justice at the Georgia Budget and Policy Institute, there are some things that seem wonderful on paper but are expensive and hard to do in practice.

The majority of Pathways’ operating expenses, which total close to $9,000 per enrollee, have come from back-end expenses. According to KFF analysts, states that have extended Medicaid spend roughly $6,500 on per enrollee in that group in 2021.

Though some Republican state lawmakers have indicated an openness to considering complete expansion, Georgia GOP Governor Brian Kemp has stated that he is devoted to his trademark health program.

Last year, a group of Democratic senators requested that the federal government suspend watchdog look into Pathwaysspending, citing KFF Health News findings.

According to Laura Colbert, executive director of Georgians for a Healthy Future, a nonprofit consumer health advocacy group, some people—such as those employed in the gig or informal economy—may not have official records and may be excluded from health coverage even with the proposed modifications. According to her, people with medical issues that prevent them from working, older folks who have trouble finding employment, and those who are caring for elderly children or relatives would still not be eligible for health coverage.

According to Colbert, the Pathways program simply doesn’t represent how people actually work. It is evident that the Pathways program was created by individuals who had held salaried positions with steady earnings.

One of KFF’s main operational initiatives is KFF Health News, a nationwide newsroom that specializes in in-depth reporting on health-related topics.the impartial resource for journalism, polling, and health policy research.

OUR WORK IS MADE POSSIBLE BY YOU.

GET THE HEADLINES FOR THE MORNING.