Measles isn't the only preventable disease spreading across the country: "Medicaid Work Requirements" hit Ohio, Iowa & possibly Idaho


CMS gives thumbs-up to Medicaid work requirements in Ohio

The Centers for Medicare & Medicaid Services has approved a waiver request for work requirements in Ohio’s Medicaid program.

...CMS rolled out guidance on these waivers in January 2018, and since then eight states, including Ohio, have had requests approved. Several additional states have submitted waivers that the agency has yet to weigh in on.

...Arkansas is the only state where such work requirements have formally been launched, and in the last several months of 2018, more than 18,000 people lost Medicaid coverage as a result of the work requirement. The Kaiser Family Foundation estimated that most of these losses were a result of the administrative requirements associated with reporting work hours.

Double Ugh:

Iowa Senate passes Medicaid work requirement bill

The Iowa Senate passed a bill Tuesday to require most Medicaid recipients in the state to work or volunteer as a qualification to receive benefits.

Senate File 538 would require the state to apply for a waiver from the federal government that would allow the Department of Human Services to impose a "community engagement activity" participation requirement on Medicaid recipients.

The bill passed on a party-line vote of 32-17. All Republican senators supported it, and all Democratic senators opposed it.

Those seeking benefits under Iowa's Medicaid program would need to work 20 or more hours per week, averaged over a six-month period, to be eligible. Recipients could also volunteer 20 hours a week, averaged on a monthly basis, to satisfy the requirements. Other state-approved programs identified by the department could be used in place of those.

State officials say about 60,000 people could be affected by the bill if it becomes law.

I assume the Iowa bill will move on to the state House next, where I suppose there's a chance that it might be stopped, since the Iowa House is less lopsided than the state Senate...but not much of one. Iowa Governor Kim Reynolds is a Republican as well, so the odds are pretty grim.

What's especially depressing about both Ohio and Iowa (as well as Arkansas, Kentucky, Michigan, etc.) is that all of these states already expanded Medicaid years ago. The programs have been plugging along for up to 5 years now witihout any justification for adding work requirements now...other than to save the state money by kicking a chunk of the enrollees off the program via a convoluted, overbearing, expensive new administrative bureaucracy.

Triple Ugh:

Medicaid bill advances with work requirements, private insurance carve-out

A House panel on Wednesday sent the latest Medicaid expansion bill in the Idaho Legislature on to the House floor, but without a recommendation to pass it.

The bill — from Nampa Republican Rep. John Vander Woude — includes controversial provisions, such as a work requirement. It also requires people who are just above the poverty line to buy private health insurance plans from Idaho’s insurance exchange.

The Idaho House Health and Welfare Committee voted to advance the bill after hearing hours of testimony from Idahoans in the Medicaid gap, their advocates and doctors, and health care trade groups who opposed the measure.

The bill includes a requirement for Idahoans to work, or be otherwise occupied (such as people who are going to college or are in work training programs), while they receive Medicaid benefits. Vander Woude’s last proposal for Medicaid expansion with sideboards included a work requirement, too, with various groups of people being exempt from the rule.

Vander Woude said the bill’s opponents have a “difference of opinion of what is a good, responsible way of implementing” the expansion, approved by 61 percent of voters under Proposition 2.

When Idaho voters passed Prop 2, they didn't say anything about adding work requirements or cutting off enrollment eligibility at 100% of the Federal Poverty was supposed to be for full expansion to 138% FPL, no strings attached:

Be It Enacted by the Legislature of the State of Idaho:

SECTION 1. That Chapter 2, Title 56, Idaho Code, be, and the same is hereby amended by the addition thereto of a NEW SECTION, to be known and designated as Section 56-267, Idaho Code, and to read as follows:

56-267. MEDICAID ELIGIBILITY EXPANSION. (1) Notwithstanding any provision of law or federal waiver to the contrary, the state shall amend its state plan to expand Medicaid eligibility to include those persons under sixty-five (65) years of age whose modified adjusted gross income is one hundred thirty-three percent (133%) of the federal poverty level or below and who are not otherwise eligible for any other coverage under the state plan, in accordance with sections 1902(a)(10)(A)(i)(VIII) and 1902(e)(14) of the Social Security Act.

(2) No later than 90 days after approval of this act, the department shall submit any necessary state plan amendments to the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services to implement the provisions of this section. The department is required and authorized to take all actions necessary to implement the provisions of this section as soon as practicable.

SECTION 2. That Section 56-262, Idaho Code, be, and the same is hereby amended to read as follows:

56-262. DEFINITIONS. The definitions contained in section 56-252, Idaho Code, shall apply to sections 56-260 through 56-266 56-267, Idaho Code.

The problem, of course, is the "Notwithstanding any provision of law or federal waiver to the contrary" part. Idaho state legislators are trying to change the law to the contrary after the fact.

It's worth noting that according to this Kaiser Family Foundation analysis from last summer, of the 43,000 Idahoans who should be eligible for Medicaid expansion, 19,000 earn between 100-138% FPL...which means the Idaho legislature is trying to cut down the number of residents eligible by around 44%.

As an aside, I should explain the discrepancy between the "133%" and "138%" figures:

Why didn’t Congress just make the eligibility level 138 percent?

The U.S. Senate passed the health overhaul bill in late 2009 with the 133 percent figure. That figure was already the minimum federal standard for pregnant women and children under 6.

The House, in its initial deliberations, favored an income limit of 150 percent of the poverty level, or nearly $35,000 for a family of four. During the process of melding the House and Senate bills, lawmakers were concerned about Senate rules that prevented them from changing the eligibility level in legislation that had already passed in the Senate. So, the reconciliation bill , which passed both chambers, included the 5 percent disregard while maintaining the 133 percent figure.

In other words, it's officially 133%, but you then "disregard" 5% for purposes of calculating your Adjusted Gross Income, making it effectively 138% FPL. Kind of confusing I admit, but there it is.