Medicaid work requirement

GLENN ELLIS | 2/12/2018, 7:52 a.m.
Today, one of the hottest political topics across the country is the impending “Medicaid work requirement.”
Medicaid recipient Thomas J. Penister, of Milwaukee, responds to a question during an interview Friday, Jan. 12, 2018, in Milwaukee. Penister does not favor a work requirement in order to receive Medicaid because of the varying circumstances of the individuals receiving the health insurance. Gretchen Ehlke

Strategies for Well-Being

Today, one of the hottest political topics across the country is the impending “Medicaid work requirement.”

Reversing a 2012 action from, when former President Barack Obama, on Jan. 11, 2018, the Centers for Medicare and Medicaid Services issued a letter to State Medicaid Directors providing new guidance for waivers that would impose work requirements as a condition of eligibility for Medicaid.

The waivers to the work requirements were the result of a welfare reform law enacted by Congress in 1996 under President Bill Clinton.

Traditionally, efforts to improve health in the United States have looked to the health care system as the key driver of health outcomes. Despite annual health care expenditures projected to exceed $3 trillion, health outcomes in the United States continue to fall behind other developed countries. There is growing recognition that a broad range of social, economic and environmental factors shape individuals’ opportunities and barriers to engage in healthy behaviors.

Medicaid was implemented to provide health benefits for low income Americans, and benefits and eligibility are based on income and house size. Originally in 1965, Medicaid categories were defined by welfare recipient status, but this began to change in the mid1980’s and ceased completely with the passage of welfare reform in the mid-1990’s. Over its’ history, the Medicaid program has expanded to a program that provides health care services to around 40 million people at a cost of $170 billion to federal and state governments. As we approach its’ 60th anniversary, Medicaid is the source of health care insurance for one in four American children and covers 40 percent of all births. Most recent reports show upward of 70 million Americans are Medicaid recipients.

So, the question looms: is establishing a Medicaid work requirement an appropriate response?

Let’s put this in some perspective. According to the Kaiser Family Foundation, “6 in 10 Medicaid adults are already working. Among those who are not working, most report illness or disability, caregiving responsibilities, or going to school as reasons for not working. Many of these reasons would likely qualify as exemptions from work requirement policies. This would leave 7 percent of the population to whom work requirement policies could be directed, including those who report they are not working because they are looking for work and unable to find a job.

More work and fewer handouts for social welfare recipients – something many clearly see as being cruel and inhumane to the poor. But, others think they’re wrong. Especially when it is done responsibly, with dignity and meaningful purpose.

A 2009 study conducted by the Center for Research on Religion and Urban Civil Society at the University of Pennsylvania and by the Manhattan Institute found that the most effective approach to addressing the work requirement was though Public-private partnerships. This is when public and private sector resources are utilized to address a societal problem or complete a project.

Increasingly, providers, payers and community organizations are collaborating to make sure individuals and families understand complex instructions.

I am fortunate to have contributed in a small way as a health educator, consulting for several organizations that provide health care to Medicaid recipients in states across the country.