Maine’s Department of Health and Human Services estimated that 20,000 unemployed Mainers will have to either find work or be denied Medicaid coverage because of new eligibility requirements proposed by Gov. LePage and recently enabled by the Trump administration. The work requirements would put 6.3 million people at risk of losing health care nationwide.
Although unsuccessful in recent attempts to repeal the Obama-era expansion of Medicaid, the GOP considers the new work requirements as a strategy to free up funding and dramatically reshape the 50-year old program.
If we truly care about able bodied, working age adults on Medicaid, then we have a responsibility to help them rise out of poverty. https://t.co/0cXxSyAmQF— CMS Administrator (@SeemaCMS) January 17, 2018
On January 11, the Department of Health and Human Services (DHHS) sent out a letter to state Medicaid directors setting up the new guidelines, which state that if you’re unemployed, able-bodied, non-pregnant, and non-elderly, you’ll have to work or volunteer or lose your Medicaid benefits.
Those familiar with Gov. LePage's perspective on Medicaid work requirements will not be surprised to learn that Maine (along with nine other states) was eager to take up the federal governments offer. Gov. LePage first announced his interest in submitting a waiver to institute Medicaid work requirements in May. He hailed Trump’s decision last week.
“Most people have something to contribute to their community through either work or volunteering, and people who can contribute should do so,” said LePage in a statement to the press shortly after the federal government issued the new guidelines. “Under our proposal, people who receive Medicaid and are able-bodied will need to work, be training for a new career, or volunteer. These work-oriented activities end isolation, build relationships, improve quality of life and help move our economy forward.”
The LePage administration wants a work requirement of at least 20 hours a week. Although a final decision from the federal DHHS is yet to be determined, the waiver will likely get approved.
Kentucky had its application approved last week, prompting lawsuit threats from advocates of the poor. Critics say the rationale for requiring Medicaid beneficiaries to work is backwards — a person can’t find a job or work unless they addresses well-being and health care needs first. This viewpoint prioritizes access to adequate health care as a foundation for success, both at home and in the workforce.
“Ripping away health care from people who have lost their jobs will not create a single job, raise anyone’s wages, or help anyone who is struggling to find work,” said Winnie Stachelberg, Executive Vice President for External Affairs at the Center for American Progress. “Instead, it kicks people while they’re down — taking away health care from unemployed or underemployed workers when they need it most.”
Stephanie Nadeau, Maine’s Medicaid director, believes the opposite. In an interview with the Phoenix, Nadeau repeated the claims touted in the federal DHHS letter, specifically that working a job leads to better health conditions. Proponents of this arrive at this conclusion because of the correlations between employment and longer life spans, and unemployment and depression.
“Medicaid has always been intended to be short term,” said Nadeau. “When individuals feel like they’re contributing to both their own financial status but also society, they’re more apt to focus on their health and focus on how they become a more stable contributing member of society. I don’t necessarily disagree that you need health insurance in order to do that but it comes down to the fundamental question of who is responsible for the provision of health insurance.”
Nadeau noted that the new guidelines come with some important parameters. Various activities like volunteering, job-training and caregiving will also be considered “work.” In addition, states are required to create exemptions for those deemed medically frail, compensate for high unemployment areas, and accommodate people in drug addiction treatment.
“There are a lot of ways an individual can meet this requirement,” said Nadeau. “Able-bodied adults should contribute to the workforce and marketplace.”
James Myall, a policy analyst at the Maine Center for Economic Policy, estimates that more than 30,000 Mainers with low incomes, and some with chronic conditions, would be subject to the work requirement, premium payments, and asset tests in this proposed waiver. Myall believes that imposing work requirements “undermines the basic principles of the Medicaid program, causes unnecessary hardships to tens of thousands of Mainers, and hurts Maine’s economy.”
“It’s a poorly thought out and harmful policy,” said Myall. “There’s no real evidence that adding work requirements to safety net programs does anything to ‘make people work.’ Many people in these programs are already working, and the primary purpose of a safety net is to help people when they need it. When people lose their jobs, suffer a crippling illness, or undergo some other crisis, they need food stamps and Medicaid the most. What they don’t need is someone in Augusta or Washington telling them they’re not trying hard enough — and snatching away the supports they need.”
Myall argues that stripping poor people’s access to affordable health care could result in many of them becoming more impoverished, not less.
“The number of Mainers reporting serious health conditions has been rising for years, and many of those individuals are too sick to work, or at least to work regularly and consistently,” said Myall. “They need more health care, not less.”