The Medicaid work requirement: A ‘blunt instrument of a bad idea’

January 14, 2019 5:01 am

State social services workers signed up homeless residents for Medicaid at a resource fair in Richmond in early November. (Ned Oliver/ Virginia Mercury)

Adrian worked a full-time job and he received health insurance through Medicaid. As it turns out, that’s a pretty common story.

For every 15 Americans on Medicaid, nine of them already have a job, according to the latest data from the Kaiser Family Foundation. Two people have an illness or disability that keeps them from working. One person can’t work because she’s in school.

And another two people can’t work because they’re caregivers, and as anyone who’s been a caregiver knows, that’s more than a full-time job anyway.

That means, of that entire group of 15, the grand total of people with Medicaid who say they’re not working for another reason is … one.

Work requirements for Medicaid are a bad policy because they force the other 14 people to jump through bureaucratic hoops and paperwork all for that one person. And as we already saw, those 14 people are pretty busy. They’re putting in a full day’s at work in an office or late nights as a caregiver.

They’re fighting a disability or an illness that keeps them from landing their next job. Some of them are buried in their books, studying hard for that certification they need to get a steady paycheck.

Work requirements aren’t even a good idea for that one person that the policy is meant to help.

Every hour he spends filling out paperwork is an hour he’s not at the community college learning a new skill, searching the job listings on the public library’s computer, or dropping off a job application downtown. But he has no choice, because he never knows when he’ll get sick.

In short, work requirements are a textbook example of politicians trying to solve a problem that doesn’t exist. In Virginia, unfortunately, we may be stuck with them.

As part of the legislative compromise to expand Medicaid to around 400,000 Virginians, Republicans in the General Assembly insisted on imposing work requirements. If we’re stuck with a bad policy, the least we can do is implement it in the least destructive way, using lessons from other states.

Adrian McGonigal is an Arkansan profiled by the Washington Post’s Catherine Rampell. He’s one of nearly 17,000 people who the state has cut from Medicaid in just the first few months of work requirements. Adrian actually had a full-time job, but he didn’t know he had to certify that job every month. When the state cut off his insurance, he couldn’t afford his medication.

His COPD flared up. He ended up in the emergency room. Eventually, his supervisor had to let him go. As Rampell notes, “A policy intended to help people get jobs instead cost McGonigal his.” What’s worse, even if the state gives him his Medicaid back, even if Adrian gets his job back, Arkansas can’t reverse the damage to his health.

Virginia can avoid similar tragedies and here are three ideas how:

First, meet people where they are. The Virginia Department of Medical Assistance Services has already said they want to pursue a “no wrong door” approach. That’s good. People should be able to report online, over the phone, in person, by mail, or by fax. And DMAS should keep looking at new ways to streamline how Virginians on Medicaid can report their work, even how to automate that reporting.

Second, match people’s schedules. Arkansas forces everyone to report online, but for some reason their website goes offline from 9 p.m. until 7 a.m. every single day. Virginia should make sure web maintenance doesn’t get between people and the health coverage they need.

Finally, be flexible. Lawmakers should empower DMAS to change course or hit pause on these requirements if the program heads into the wrong direction. For example, if the state begins receiving a flood of non-responses, that might be a warning that people simply don’t understand the new requirements. They shouldn’t automatically lose their coverage because of that.

None of these steps are easy. But if lawmakers truly want more Virginians to get jobs, they can’t take shortcuts or let working families shoulder all the risk like Arkansas did, and as states like Kentucky, Indiana, Wisconsin and New Hampshire are poised to do.

Virginia has to be more thoughtful because, as Arkansas shows, President Donald Trump’s administration simply is not willing to use its scrutiny and oversight to protect people’s health insurance. In the process, they will let the health care disparity between states grow even wider. Virginians need to make sure we’re not caught on the wrong end of that divide — by speaking out and calling their delegates and state senators.

We need smart reforms to Medicaid, not the blunt instrument of a bad idea.

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Brian Chiglinsky
Brian Chiglinsky

Brian Chiglinsky of Falls Church works in health care communications. A former director of speechwriting at the United States Department of Health and Human Services, he has worked in state, local and federal government. His views are his own and do not represent those of any other organization.