Report: Medicaid Work Requirements Problematic

 A move to create work requirements as a condition of eligibility for Medicaid recipients could complicate and even eliminate life-saving healthcare for over two million Michiganders on Medicaid, including the 675,000-plus enrolled in the state’s Medicaid expansion program, a report by the Michigan League for Public Policy has determined.

Medicaid is a program enacted in 1965 that helps elderly adults, people with disabilities and families with low incomes to receive health insurance. Under former President Barack Obama’s Affordable Care Act, the program could be expanded to allow people earning up to 138 percent of the federal poverty level be part of the program. Michigan was one of the states that expanded Medicaid through the program known as Healthy Michigan.

And while Healthy Michigan had some stipulations for beneficiaries, it did not include a work requirement. In fact, no such policy has ever been created in the more than 50 years of the program, until now, thanks to a guidance issued in January by President Donald Trump and his federal Department of Health and Human Services and the Centers of Medicare and Medicaid Services.

So far only three states – Arkansas, Kentucky and Indiana, the last of which is the home state of Vice President Mike Pence –  have implemented such work requirements since being given the green light by Trump.

The report by the Michigan League for Public Policy (MLPP) found numerous concerns with this idea, which has, in Michigan, been raised by Republicans Rep. Gary Glenn of Williams Township in Bay County and Gary Howell of North Branch in Lapeer County via House Bill 5317. The bill was introduced and referred to the House Appropriations Committee in December.

Among the concerns raised by MLPP were:

  • Lost healthcare coverage and burdensome bureaucracy would be had for recipients due to complex paperwork for exemptions, coverage “lockouts” for noncompliance, and additional requirements for employers;
  • High cost for implementation and the savings coming largely from people losing healthcare;
  • Legality, given one of the three states has already been subject to a lawsuit; and
  • Exemptions would be hard to get because of narrow definitions and the difficulty of obtaining medical records and other documents recipients would need.

“Michigan legislators must look at the human and financial costs of attempting to implement work requirements, especially with the growing data and information that shows they are likely to cause more harm than good,” said Gilda Z. Jacobs, president and CEO of the MLPP. “Medicaid work requirements will likely come with a hefty price tag to both the state and federal government, and with major questions about legality, they are more likely to be settled with a gavel in a courtroom than a gavel in the Capitol.”

The idea behind the policy has been a staple of the Republican Party by feeding a heavily disputed narrative that people receiving assistance from the government are lazy.

However, a study by the University of Michigan found that of those enrolled in the state’s Medicaid expansion program, nearly 50 percent of them were employed and only 27.6 percent of enrollees were out of work, with many saying poor health status, chronic illness or mental illness was the reason for that. The rest of those surveyed who were not working stated they were unable to work due to fair or poor health (11.3 percent), or because they were retired (2.5 percent), students (5.2 percent) or homemakers (4.5 percent).

And other studies related to Medicaid employment nationwide found six out of 10 non-elderly Medicaid enrollees working, and eight of 10 Medicaid enrollees living in a household where someone is working.

“Too often we see politicians burdening Michiganders in need with harsh requirements and confusing red tape,” Jacobs said. “It would be more productive for Michigan lawmakers to invest in job training and continued support for Medicaid and other assistance programs, without which many Michiganders would lose access to valuable health coverage that allows them to work and provide for their families.”

Danielle Emerson

Danielle Emerson