Medicaid Work Requirements Need Lawmaker Action

Thirty-one-year-old Arkansas resident Conisha Gatewood was recently referred to an obstetrician-gynecologist for nonstop menstrual bleeding but was told she didn’t have insurance once she got to the clinic. She was shocked because, like thousands of Arkansas residents, Gatewood went through the online-only process of signing up for Arkansas Works, the state’s Medicaid program.

“I was so confused,” Gatewood told the New Hampshire Union Leader. “I already had a job. No one could tell me what I needed to do.”

From hearings to bill introductions, policymakers have made an effort to address key health issues like drug pricing and surprise medical bills. Still, little progress has been made on the issue of Medicaid work requirements, leaving tens of thousands of Americans like Gatewood in the lurch.

While congressional Democrats have recently decried the implementation of work requirement policies in a letter to the administration, there has yet to be significant movement on the issue. It’s time for policymakers to take action before the health care of millions of our most vulnerable citizens is put at risk.

The Centers for Medicare and Medicaid Services began providing guidelines for states to institute work requirements on Medicaid recipients in January 2018. Since then, nine states have had their work requirement programs approved by CMS. An additional six states are awaiting approval.

Some state lawmakers peg work requirements to health care access based on the idea that Medicaid recipients are out to game the system. In reality, the majority of non-disabled adult Medicaid beneficiaries already work at least part time, according to the Kaiser Family Foundation.

Most of those who don’t work cited reasons such as illness or disability, caregiving responsibilities, or being in school. Yet, when the false perception that Medicaid enrollees are freeloaders is codified into law, as in Arkansas, the result can be catastrophic, with penalties including loss of coverage and long waits for re-enrollment.

In Arkansas alone, since work requirements were implemented, over 18,000 consumers lost coverage. Fortunately, for those covered by Medicaid in Arkansas and Kentucky, a federal judge recently blocked Kentucky from implementing work requirements and Arkansas from continuing its program. However, Kentucky Gov. Matt Bevin (R) has threatened to end Medicaid expansion unless Kentucky can move forward with implementing work requirements, a decision that would drop over 400,000 new Medicaid enrollees.

These lawsuits continue to put health care consumers in the middle, creating uncertainty about their coverage, and their health will undoubtedly suffer as a result. Bold and urgent congressional leadership is needed to address this uncertainty.

If work requirements were implemented nationwide, the Center on Budget and Policy Priorities estimates that between 1.4 million and 4 million people among the 23.5 million adult Medicaid enrollees who are under 65 and not receiving Supplemental Security Income based on disability could lose coverage. These numbers demonstrate that stringent Medicaid work requirements — such as online-only enrollment — pose an unreasonable burden on consumers and erect regressive barriers to health care for our most vulnerable communities.

Problematic administrative barriers affect multiple aspects of Medicaid. A new report from Families USA shows Medicaid enrollment decreased by 1.6 million last year, including 744,000 children, which experts attribute to convoluted processes to redetermine Medicaid eligibility. When people are losing essential health care coverage at rapid rates, simply due to administrative burden, it’s clear that the program is failing to deliver on its vision of helping beneficiaries achieve “their highest level of health.”

When President Lyndon B. Johnson signed Medicaid into law in 1965, former President Harry S. Truman was by his side. Truman had long dreamed of a social safety net health program. At his State of the Union address in 1948, Truman stated, “This great nation cannot afford to allow its citizens to suffer needlessly from the lack of proper medical care.”

More than 70 years later, burdensome Medicaid reporting requirements are threatening Truman and Johnson’s vision for Medicaid, a vision that so many have worked tirelessly to deliver and that millions — past and present — rely on for essential health care coverage. Policymakers must address regressive obstacles to Medicaid and work to increase access to care, rather than impose administrative red tape on hard-working Americans. Their health — and our great society — depend on it.


Jason Resendez is a board member of Consumers for Quality Care and executive director of the LatinosAgainstAlzheimer’s Coalition.

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