In January 2018, the Centers for Medicare and Medicaid Services (CMS) issued guidance to state Medicaid directors on how to apply for a waiver to create work requirements for participants to remain eligible for the program. So far, three states — Arkansas, Indiana, and Kentucky — have been approved, and at least six more states are pending approval to institute work requirements in their Medicaid programs.
Quite simply, work requirements refer to states imposing employment criteria for participants in certain programs, like Medicaid. Prior to this year, no state has ever received permission from the federal government to apply such requirements to its Medicaid program.
A work requirement within Missouri’s current Medicaid system would create a situation where participants would become disqualified from the program for complying with the program requirements.
This is a major shift in Medicaid, which has functioned as a health coverage program since it began over 50 years ago, to operating more similarly to welfare programs. There are also practical challenges to effectively implement a work requirement for Medicaid as outlined by CMS.
Implementing a work requirement could be costly to the state. Proposals currently before the Missouri General Assembly are estimated to have a potential cost to the state of almost $10 million each year to monitor just over 10 percent of Medicaid participants.
Seniors, pregnant women, and people with disabilities must be exempt from meeting work requirements, but they could still become entangled in bureaucratic red tape while proving they do not have to comply.
Missouri’s Medicaid system is already operating with software decades out of date and plagued with glitches that incorrectly disenroll participants. A Medicaid work requirement creates an additional opportunity for our outdated and error-prone system to disenroll eligible people who have no other health coverage options.
Further complicating this issue is Medicaid expansion. Unlike Missouri, the three states that approved work requirements have already expanded Medicaid eligibility. Missouri currently has some of the lowest income limits for Medicaid eligibility in the U.S.
As Missouri restricts childless adults from participating in Medicaid, a work requirement would most directly affect very low-income parents, often single mothers. It is estimated that about 65 percent of people who would be subject to a Medicaid work requirement but do not already comply are not working because they have an illness or disability.
A work requirement at Missouri’s current eligibility levels would create a predicament where, for most parents, working 20 hours per week at a minimum wage job would disqualify the participant on the basis of income. In other words, a work requirement within Missouri’s current Medicaid system would create a situation where participants would become disqualified from the program for complying with the program requirements.
At Paraquad, our mission is to empower people with disabilities to live as independently as possible with choice and opportunity, and we know that is attained through economic freedom and self-sufficiency.
That means employment.
This is why we advocate for the Ticket to Work Health Assurance Program that allows people with disabilities to work and continue to be eligible for the services that help someone get out of bed and get dressed in the morning, and why we recently opened Bloom Café where people with disabilities learn job skills and find permanent employment in the community.
Missourians have the ability and desire to work and be successful. Adding a work requirement to Medicaid as proposed does not address the fundamental idea of work as a path out of poverty or improve health outcomes.
Current proposals are more likely to exacerbate existing challenges within our current Medicaid program. Organizations within the state are already present at the intersection of work and health care, and know what is needed for people stay healthy and working.
There are opportunities to address both issues without adding costly bureaucracy or further jeopardizing the futures of Missourians seeking to rise out of poverty.