Work Requirements

Georgia is one of just ten remaining states which is still holding out on fully expanding Medicaid to all legal residents earning up to 138% of the federal poverty level under the Affordable Care Act. Instead, back in 2019, GOP Georgia Governor Brian Kemp submitted a Section 1115 waiver which included a plan to partially expand Medicaid to some uninsured Georgia residents...except with a work reporting requirement for enrollees attached to it.

The program was called "Georgia Pathways," it was approved by the Trump Administration, and unlike several other states which had work requirement provisions shot down by various judges, Georgia's managed to slip through. It was scheduled to go into effect in 2021 and was supposed to be valid until September 30, 2025 before having to be resubmitted for renewal.

The incoming Biden Administration's HHS Dept. put the kibosh on the work requirement provisions of the program. Georgia successfully challenged the administration and Georgia Pathways went into effect last summer...but is still currently scheduled to sunset next September.

Back in September, Inside Health Policy reporter Dorothy Mills-Gregg checked in on "Georgia Pathways," the Peach State's new program which partially expands Medicaid to residents earning up to 100% of the Federal Poverty Level (FPL), but with a rather significant string attached: Work reporting requirements:

As noted by Madeline Guth of the Kaiser Family Foundation last year:

...in spite of nearly every state which tried to (or succeeded in) implement Medicaid work requirements having their programs shut down by the courts, one state's work/reporting managed to survive: Georgia. As explained in the Kaiser article:

Over at Inside Health Policy, Dorothy Mills-Gregg has decided to check in on "Georgia Pathways," the Peach State's new program which partially expands Medicaid to residents earning up to 100% of the Federal Poverty Level (FPL), but with a rather significant string attached: Work reporting requirements:

As noted by Madeline Guth of the Kaiser Family Foundation last year:

...in spite of nearly every state which tried to (or succeeded in) implement Medicaid work requirements having their programs shut down by the courts, one state's work/reporting managed to survive: Georgia. As explained in the Kaiser article:

During this springs Congressional kabuki theater regarding raising the federal debt ceiling, one of the biggest points of contention was House Republicans insistence on tying work requirements (w/stringent reporting) to Medicaid eligibility.

"Work requirements" is as old a saw for Republican politicians as "selling insurance across state lines," and it's just as ineffective and counterproductive (as well as simply being cruel). This debate has been held numerous times before, and the upside of such requirements has been debunked repeatedly, but here he go again:

As Joan McCarter of Daily Kos put it way back in 2015:

 

This just in, via CBS News:

The House on Wednesday passed a bill that would raise the debt ceiling and slash trillions of dollars in government spending, delivering House Speaker Kevin McCarthy a victory in his efforts to pressure the White House to begin negotiations ahead of a fast-approaching deadline to avoid a default.

The House voted 217 to 215 to pass the Limit, Save, Grow Act of 2023, with all but four Republican members voting in favor. The Republicans who voted against the bill were Reps. Ken Buck of Colorado, Andy Biggs of Arizona, Tim Burchett of Tennessee and Matt Gaetz of Florida. No Democrats supported its passage.

The measure would lift the debt ceiling by $1.5 trillion or until the end of March 2024, whichever comes first, and cut spending to the tune of $4.5 trillion.

Those cuts mean it's dead on arrival in the Democratic-controlled Senate and President Biden has vowed to veto it.

I last updated my Michigan Medicaid expansion tracking back in January.At the time, I noted that enrollment in this ACA programhas increased dramatically here in Michigan since the COVID-19 pandemic struck, increasing from 673,000 in February 2020 to 853,000 as of January 2021, or nearly 27% in less than one year.

As of April 5th, the Healthy Michigan program (that's the branding of Michigan's ACA Medicaid expansion) notes 897,261 enrollees. That's a net increase of 224,000 Michiganders enrolled in the program since last February, or over 33%.

With this as backdrop, consider the timing of the following events:

 

Nearly six years ago:

In other words, only about 10% (at most) of those still in the Medicaid Gap could remotely match the GOP's cliche of a "lazy, good-for-nothing layabout" type who's able-bodied, has no serious extenuating circumstances and so forth. The "get off your ass and work!" requirements appear to be nearly as big a waste of time and resources as the infamous "drug testing for welfare recipients" bandwagon which a bunch of states jumped on board over the past few years.

I suppose this was inevitable, but it's grating nonetheless, and especially so given that we're in the middle of a pandemic which has caused tens of millions of Americans to lose their jobs:

The Supreme Court agreed Friday to consider a Trump administration plan to let states impose work requirements on some who receive health-care benefits under the Medicaid program for the poor.

Arkansas and New Hampshire want to continue programs halted by lower courts, and more than a dozen other states say they want to impose similar requirements.

But despite the Supreme Court’s willingness to take up the issue, the incoming Biden administration might have other ideas, and opponents called on it to reverse endorsement of the work requirements.

One by one, the dozen or so states which had either already implemented work requirement programs for Medicaid expansion enrollees or which were planning on doing so have either "delayed" or dropped those requirements entirely, either by force due to a federal judge ruling against them, or "voluntarily" due to them seeing the writing on the wall and realizing that a federal judge was going to rule against them in the near future.

Every state except one, that is: Utah.

Utah passed ACA Medicaid expansion solidly back in 2018...and they passed a "clean" version, which was supposed to mean anyone earning up to 138% of the Federal Poverty Line would be eligible, and the program wouldn't have any barriers or hurdles like work requirements and so forth.

This just broke moments ago so I don't have much in the way of details yet:

DC district court just entered summary judgment holding Michigan’s Medicaid work requirements are unlawful.

— Jane Perkins (@perkins_nhelp) March 4, 2020

Work requirements are a policy disaster -- and their suspension by court order here in Michigan is an extraordinarily positive development.

— Nicholas Bagley (@nicholas_bagley) March 4, 2020

There is, however, also this:

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