Health Advocates Urge Rejection of Medicaid Work Mandates in Non-Expansion States



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Mississippi, Oklahoma, South Dakota, Tennessee and Alabama have all asked the Trump administration to allow them to implement work requirements.

Federal health officials should reject requests from five states that haven’t expanded Medicaid but want to move forward with work requirements on current recipients, doctor organizations and advocacy groups urged in a letter this week.

The Centers for Medicare & Medicaid Services is currently examining the requests from Mississippi, Oklahoma, South Dakota, Tennessee and Alabama. While about a handful of states have received permission from the agency to impose work requirements on some recipients, they are all those that expanded Medicaid insurance coverage under Obamacare. 

These five states are different, asking to require some amount of work for many adult recipients who qualified for the program under the previous, much more restrictive, Medicaid eligibility requirements. For the most part, this means those affected would be people with extremely low incomes and likely parents—particularly single mothers, the letter says. 

The letter, sent March 6 to Health and Human Services Secretary Alex Azar, was signed by dozens of organizations, including the American Academy of Pediatrics, the Georgetown University Center for Children and Families and the March of Dimes.

So far, only Arkansas has actually kicked people off the Medicaid program with the implementation of a work mandate, which in that state requires recipients to either work 20 hours a week, get job training or volunteer. It has meant that 18,000 people lost coverage through the end of last year. Indiana started its work requirement in January, but won’t enforce it until the summer. In these states, like the 34 others that have also expanded Medicaid, people can get on the federal insurance program if their income is up to 138 percent of the poverty level, or $28,676 for a family of three. 

Noting the loss of coverage in Arkansas, the letter argued that people currently on Medicaid in the five non-expansion states asking to use work requirements would be less able to pay for health care without coverage. “In Alabama, for example, only the poorest parents and caregivers, those making 18 percent of the poverty level or less—$3,740 a year for a family of three or about $312 a month—now qualify,” the letter says.

In Arkansas, critics say that the work requirements have unfairly penalized people who haven’t been able to get online to report work or aren’t well enough to hold down regular jobs. But proponents, like Gov. Asa Hutchinson, say the mandate has resulted in people getting work to keep coverage, while emphasizing that only those without children must comply.

"We are simply saying if you are able-bodied and able to work, and you don't have dependent children at home, you ought to either be working or you ought to be in school or you ought to be volunteering or contributing,” Hutchinson told NPR last month.

In Mississippi, state officials have tried to address concerns that people working even a minimum wage job for 20 hours a week make too much money to keep getting Medicaid coverage in the state, while not providing them with enough income to afford private health insurance. The state has told the federal government they will provide these recipients who start working with two hours of transitional Medicaid coverage, the Clarion Ledger reported last summer.

While the Trump administration has approved work requirement plans for expansion states, CMS administrator Seema Verma has specifically noted the complications in states with just a traditional Medicaid population. "We're dealing with a vulnerable population, so we want to be careful,” she said.

A federal judge next week will hear arguments in a lawsuit seeking to stop the Arkansas mandate, as well as the Kentucky requirements. The same judge last year blocked Kentucky from moving forward with its plan, but the federal health agency has since re-approved the requirements. They are set to go into effect this spring.

Laura Maggi is Managing Editor at Route Fifty and is based in Washington, D.C.

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