Montana Republicans Discuss Work for Getting Medicaid – Welfare

Across the country, Republicans have begun to realize a long-held goal of requiring able-bodied adults to work, get job training or perform community service in exchange for receiving health coverage through Medicaid.

House District 12 State Representative Greg Hertz from Polson said on Friday that the topic had come up in discussions with fellow legislators meeting in Helena last week.

“I think the majority of Republicans support some type of work requirement, not only for  Medicaid, but also for other welfare-type benefits, whether its food stamps or healthcare benefits that people receive,” said Hertz. “A recent survey said that 8o percent of Americans support some type of work requirement for those receiving welfare benefits. However, it requires a waiver from the Governor, who has not followed through with the requirements within the legislation. I spoke with Senator Ed Buttrey who sponsored the Medicaid expansion legislation and he was a little discouraged that the governor hadn’t followed through on everything that was in that legislation.”

Montana Medicaid is set to sunset in 2019 and Hertz said a great deal more money will be required to support the program.

“If we’re going to continue it we’re going to require a significant increase in funding,” he said. “We just saw that 91,000 people have signed up so far and that’s more than double what we thought, so it’s probably going to cost us upwards of $100 million a year, so we’re going to need that money to continue it.”

Hertz said the so-called ‘rainy-day fund’ is completely exhausted after last year’s fire season.

“It’s also getting to be election season, so everyone needs to be informed on the issues and look at the candidates and vote accordingly.”

 

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Medicaid program needs to have work rules implemented

If government gives you a cash handout or a “free” service, and you are capable of working, studying or providing service to the community in exchange for your public assistance, should you be obligated to do so?

Most conservatives say yes. Most progressives say no. Most Americans agree with the conservatives on this position, much to the dismay of the progressives.

This is not a theoretical question here in North Carolina. A couple of years ago, the administration of former Gov. Pat McCrory instituted a requirement that recipients of the Supplemental Nutrition Assistance Program — known as SNAP, or what used to be called food stamps — had to comply with a work requirement as long as they were able-bodied and didn’t have dependent children.

Also, a couple of years ago, McCrory and the N.C. General Assembly fashioned a reform plan to introduce more managed care within the state’s Medicaid program. One element of the resulting Medicaid waiver submitted to the federal government was a proposed work requirement for North Carolina recipients — again, for those whose health conditions and caregiving responsibilities would allow it.

Responding to several applications, including North Carolina’s, the U.S. Department of Health and Human Services has just ruled that states can institute Medicaid work requirements. Within hours, Kentucky became the first state to do so.

There is a robust policy debate about the efficacy of work mandates. Do they cost more to administer than they save in benefits paid? How many welfare recipients are truly capable of working? What if jobs are hard to find? What other activities — enrollment in job training, for example, or volunteering — ought to satisfy the requirement?

These are all important questions. But to me, there is a more fundamental principle at stake. If the government is to be in the public assistance business at all, the strongest case for support involves the aged, the infirm, the disabled, and orphaned children. These are individuals who can’t take care of themselves, at least not to a large degree.

Their relatives ought to be their primary caregivers. That’s what family is for. But in cases where family resources and private philanthropy prove to be insufficient, most North Carolinians support not just a temporary safety net but long-term public assistance.

For able-bodied people who don’t fit these categories, most people see government’s proper role as much more limited. Whatever temporary assistance might be rendered, they should be moved as rapidly as possible into work, self-sufficiency and self-respect.

A combination of time limits and work requirements is necessary in order to combat welfare dependency, which otherwise saps initiative, unravels families and communities, and creates multi-generational cycles of poverty.

If work-or-service requirements for able-bodied Medicaid recipients are too hard to define or costly to administer, that becomes a strong argument not to allow such recipients on Medicaid in the first place — at least not in a free society where government is supposed to be minimized, personal freedom is supposed to be maximized, and personal responsibility is supposed to be the default, not merely an aspiration.

Medicaid is the primary welfare program in the U.S. It is far larger and more expensive than cash assistance, SNAP or public housing. It is one of the fastest-growing expenses in federal and state budgets.

If work requirements don’t apply to Medicaid, then the full potential of welfare reform will never be realized.

Because North Carolina has not liberalized its eligibility standards under the Affordable Care Act, we don’t have very many Medicaid recipients who’d be subject to work requirements. Still, as we know, North Carolina Democrats and progressive activists desperately want Medicaid expansion to happen.

I truly think it would be a prudent decision if they dropped their opposition to work requirements and cooperated with Republicans in devising some sensible rules. That would undercut one of the main arguments conservatives have used, so far successfully, to rebut the special-interest pressure (primarily from hospitals) to expand Medicaid.

That’s what I think the left SHOULD do. That’s not what I think the left WILL do.

John Hood is chairman of the John Locke Foundation and appears on “NC SPIN.”

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Bill to expand Idaho Medicaid could keep conversation going, says senator

A Boise senator filed a personal bill Friday to expand Medicaid in Idaho, saying lawmakers need to keep that idea in mind even as they consider other options.

The bill from Democratic Sen. Maryanne Jordan was filed on the final day for personal bill introductions in the Senate. Personal bills don’t have to first clear a committee before they’re introduced.

“I did it because we are going to have substantive discussions this year on health care, and I think it’s important to continue to measure the cost of any new programs against the cost of a Medicaid expansion,” Jordan said. “That, and frankly it’s quite a demand from people in my district — they want to see it.”

Jordan noted that having been introduced as a personal bill, the measure will be assigned a bill number and will be on the record and available for the public to read on the Legislature’s website. “Sometimes when you’re in a minority position, it’s a tool you can use to advance a conversation,” she said. “I don’t have any illusions of it being passed, unfortunately.”

Idaho lawmakers have refused to expand Medicaid as states have the option to do under the Affordable Care Act. Thirty-two states plus the District of Columbia have expanded Medicaid, meaning that working poor residents can get health coverage through Medicaid, largely at the federal government’s expense. Idaho’s decision not to expand Medicaid created a healthcare coverage gap in the state under the Affordable Care Act, as an estimated 78,000 Idahoans didn’t make enough money to qualify for subsidized insurance plans through the state insurance exchange, but made too much to qualify for Idaho’s limited Medicaid program.

Gov. Butch Otter this year is proposing that the state seek two waivers from the federal government to allow a portion of that gap population — about 35,000 Idahoans whose earnings fall below the federal poverty level — to qualify for exchange subsidies, and to shift 2,500 to 3,500 of the sickest patients now covered through the exchange to Medicaid to lower costs for exchange plans.

Separately, a citizens group is gathering signatures to place an initiative on the November ballot to expand Medicaid in Idaho.

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Proposed Medicaid co-pays cause concern among advocates, lawmakers

PROVIDENCE, R.I. (WPRI) – Governor Gina Raimondo’s proposal, which would implement new Medicaid co-pays, is raising concerns among local advocates and lawmakers from both sides of the aisle.

Under the proposed budget, adults in the Medicaid program would be required to make co-payments on certain services. Patients would pay $3 for non-emergency hospital visits, $8 for non-emergency visits to the emergency room, and $3 for non-preventative doctor visits. They would also be required to pay $2.50 for generic prescriptions and $4 for brand names. State officials believe the co-pays would save roughly $3.2 million a year.

Nearly one in three Rhode Islanders receives Medicaid, the state-federal health insurance program for low-income people. In Rhode Island, it costs more than $2 billion a year.

Linda Katz, policy director for the Economic Progress Institute in Providence, said she’s concerned the co-pays could dissuade Medicaid recipients from seeking medical attention or getting their prescriptions. She said under the guidelines, individuals who qualify for Medicaid can make no more than $16,600 a year, or for a family of three, about $28,000 annually. For those who are worried about paying rent or putting food on the table, Katz believes the co-pay could be a major hurdle.

“Even that small amount of money could mean well, I’m not feeling so well, but I won’t go to the doctor today because I really can’t afford to shell out $3,” she said.

Rhode Island wouldn’t be the first to implement such a program. Twenty-four other states, including Massachusetts, require adult Medicaid recipients to contribute to some of their services. Katz said she doesn’t think Rhode Island should fall in line with those other states.

Others, including lawmakers from both parties, agree.

“I am concerned with how these co-pays could potentially discourage seniors, the disabled, and the poor from seeking treatment when they are sick, or not filling the prescriptions they need because they cannot afford ongoing co-payments,” said Sen. Jeanin Calkin in a statement.

House Minority Leader and Republican candidate for governor, Patricia Morgan, said she’s concerned how the proposal would impact the working poor.

“The good news is almost every Rhode Islander has healthcare and we’re going to keep it going, the budget I proposed has no cuts in eligibility,” Governor Gina Raimondo said in this week’s taping of Newsmakers. “But Medicaid is one of the largest faster growing parts of the budget.”

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McCaleb: Medicaid work requirements for able-bodied, childless adults make sense

Helping people when they’re down is admirable.

Helping people who are down learn how to help themselves is both admirable and far more sustainable, financially, in the long term.

That’s why the Trump administration’s decision last week to allow U.S. states to develop work-requirement programs for healthy, childless Medicaid recipients is a smart one. Under the new guidelines, individuals with disabilities and small children, women who are pregnant, and the elderly would be exempt from the work requirements.

Those most in need, then, are not affected.

Kentucky was the first U.S. state to become eligible to impose the mandatory work requirement. Illinois should get in line to become one of the next.

Medicaid is a taxpayer-funded health insurance program that was created in the 1960s to provide coverage for the most at-risk Americans, including those in extreme poverty and people with disabilities who are unable to work. But when Obamacare was enacted in 2010, it expanded Medicaid eligibility to all lower-income Americans in states that opted in. That allowed healthy, childless individuals for whom Medicaid was not initially intended to sign up for the welfare program.

In 2013, Illinois opted in to full Medicaid expansion. Since then, the state’s Medicaid rolls have exploded. More than one in every four Illinoisans now are covered by taxpayer-funded Medicaid.

And, as can be expected, the costs have soared as well.

During fiscal year 2016, combined federal and state spending for Medicaid in Illinois exceeded $19 billion, an increase of 44 percent since 2012. Illinois’ share is more than $5 billion, and that’s only going to increase as Congress shifts more of the expansion costs to state governments.

A U.S. Senate committee is investigating the rising costs of Medicaid in Illinois and seven other U.S. states that opted into to the expansion.

In a letter to Gov. Bruce Rauner this past fall, the committee’s chairman, Sen. Ron Johnson, R-Wisconsin, said Illinois’ Medicaid expansion costs are exceeding initial estimates by 90 percent, nearly double.

“Costs per enrollee are also surging in Illinois, going from $1,867 in 2014 to $5,854 in 2015 – a 214 percent single-year increase,” Johnson wrote. “I am seeking to better understand these rising costs and higher-than-expected enrollment, especially in states where costs or enrollment are increasing especially quickly.”

Illinois is in no condition to continue absorbing these out-of-control costs. A work requirement would incentivize many healthy Illinoisans who enrolled in Medicaid through Obamacare to look for work. Some percentage of them would find it and move to privately funded insurance, saving taxpayer money.

Rauner said last week that he supports work rules for able-bodied Medicaid recipients. But he also said there aren’t enough good jobs in Illinois to support it.

“We don’t have jobs available for everyone, and that’s got to be our priority – because you can force people to work but if there’s not a work opportunity, that’s not going to succeed,” Rauner said in touting reforms to tax and regulatory policies that have stifled Illinois’ jobs creators.

Rauner is correct about Illinois’ lagging jobs situation, but that shouldn’t prevent the state from adopting Medicaid work requirements.

Under Kentucky’s model, healthy adults who want to receive health care benefits would need to complete 80 hours of what that state calls “community engagement” each month to remain eligible. Community engagement can mean actually working in a job, but it also includes continuing education, community service and job training. And, to be clear, the requirement in Kentucky is 80 hours a month – not 40 hours a week, as most full-time jobs require. Illinois can form its own requirements to best fit the state.

Other federal welfare programs, such as the Supplemental Nutrition Assistance Program (otherwise known as food stamps), allow for work requirements, although the federal government makes it too easy for states to apply for and receive waivers. Illinois successfully sought a waiver for its SNAP program in 2018.

Work requirements offer good motivation for childless, able-bodied individuals to learn new skills, enhance their future earning power and become productive members of their communities.

This is a no-brainer.

Rauner should start working on Illinois’ requirements immediately.

Dan McCaleb is news director of Illinois News Network and the digital hub ILNews.org. He welcomes your comments. Contact Dan at dmccaleb@ilnews.org.

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Admit it, Medicaid maze just a way to hassle low-wage workers

The summer before I started college, I cleaned rooms at the Holiday Inn in the county seat about 15 miles from my family home.

I learned a lot that summer.

There was the motel manager who liked to come and sit with the maids as we ate lunch, mooching food from these hard-working, poorly compensated women. Occasionally he made stupid jokes, including the one about how the Kotex disposal bags could be used for popcorn, too. Long before #MeToo, we just rolled our eyes and wished he’d let us eat in peace.

There was the maintenance guy, a classic curmudgeon, who dealt with complaints about hot rooms (this was Arkansas in the summer) by adjusting the thermostats so they’d display lower temperatures — “people will think they’re cooler.”

But the reason I’m writing isn’t to share memories of my introduction to incompetent and inconsiderate male behavior in the workplace.

Instead, this came to mind as I thought about Gov. Matt Bevin’s plan to create a maze of rules that poor working people covered by Medicaid must navigate to maintain access to health care.

Make no mistake about it, although he presents the changes to Medicaid as tough love that will push able-bodied people who aren’t working back into the realm of self-affirming employment, in reality it will simply be another burden on people like my former co-workers.

The state will save money not by guiding people to economic independence but by confounding them with a muddle of requirements. Bevin’s plan anticipates that many won’t be up to sorting through the red tape and so will fall off the Medicaid rolls.

For example, under the changes, Medicaid recipients might be required to take financial literacy classes and notify Medicaid anytime their income changes. Regardless, they want every Medicaid recipient to report in monthly, apparently to re-justify their worthiness for basic health coverage.

Sitting in your office with a guaranteed annual salary, that might not seem so oppressive. But hard, physical work like cleaning motel rooms, or waiting tables or any of the other low-paying jobs that Medicaid recipients perform, makes you tired — physically and mentally. That summer I was mentally alive on the drive to work, thinking about what I was reading, cogitating on world problems, etc., etc. But on the way home, it was all I could do to stay on the road and find my exit. Much less take notes at a financial literacy class.

And income changes? It wasn’t uncommon for me to show up and be told I was only needed for the morning, so I’d wind up with a 30-mile round trip and just three or four hours of minimum-wage earnings to show for it. I’m sure my help wouldn’t have been needed in the fall when vacation season was over.

Think about it: How many of Kentucky’s low-wage workers — in restaurants, hotels, bars, retail shops — are slammed during busy seasons but hardly needed the next week? What happens when a snowstorm hits and everything closes, a racing meet ends or thousands of students at the University of Kentucky leave for the summer?

Kentucky, under Bevin, now wants Medicaid recipients to report to the state every month about their wages (and to pay premiums — I’m not even going there). Back in the day, my coworkers and I had stable housing so, perhaps, if we had the physical and mental energy and (these days) access to a computer and the internet, we might have been able to report every month.

But what about the tens of thousands of low-wage Kentuckians who move frequently? How convenient will it be for them to keep their records and documents in order and report monthly? What if a child gets sick or a car breaks down to further complicate things? Can any of us say we’ve never missed a payment or a deadline?

But in Bevin world, those things aren’t supposed to happen, I guess. Or if they do and you miss reporting to Big Brother Medicaid bureaucrats, you could be shut out of health-insurance coverage for six months or more.

Low-wage workers put up with a lot for very little. It’s a crime that Bevin wants to make them put up with even more.

Editorial writer Jacalyn Carfagno can also be reached at 231-1652.

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BOHANON & CUROTT: States need freedom to try to fix Medicaid

Economic Analysis Cecil Bohanon and Nick CurottIn an unprecedented move, the Trump administration opened the door for states to require able-bodied, working-age Medicaid recipients to work or lose coverage. What we like about this decision isn’t so much the policy per se, but rather that it demonstrates a willingness to allow states the freedom to experiment with changes that might improve the Medicaid program.

Everyone knows Medicaid as currently constructed has problems: For instance, it is a costly program that will put an increasingly large fiscal burden on state taxpayers. And it too often fails to deliver good health outcomes for birthing mothers and their babies. But what is the best way to reform Medicaid? Yes, there are conflicting views, but no shortage of ideas. What’s missing is a mechanism for testing these ideas to find out which ones work best.

That’s why it is important to decentralize the decision-making process and allow states freedom to explore many options. A great strength of our federalist system of government is that it allows for trial and error. Each state acts like a laboratory, with successful experiments being copied by other states. Unfortunately, the bureaucrats in Washington often think that, because they are experts, they must know the best solution. They then force conformity on all jurisdictions.

What about the policy of requiring healthy Medicaid recipients to work? First, the working requirement won’t apply to the handicapped, elderly or pregnant—the majority of recipients—so the effect on overall employment in the economy will be small. But there are surely some able-bodied Medicaid recipients who do not work because they are afraid they will lose their benefits. To require them to work is probably good for them, as it builds work skills and earning power that, we hope, will allow them to escape dependency.

However, the whole point of Medicaid is to benefit poor households. Once a household earns enough income to stop being poor, it loses the benefit. So there is still a strong incentive for such households to suppress earnings to preserve their Medicaid benefit. A work requirement does little to remove this flaw.

It is unclear whether work requirements will do much at all. But this is precisely the reason we need experimentation—to generate information about what works and what doesn’t. This is a move in the right direction, and we hope it signals more freedom to come.•

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Bohanon and Curott are professors of economics at Ball State University. Send comments to ibjedit@ibj.com.

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The trouble with Medicaid work requirements

Kentucky Gov. Matt Bevin, acting out of an abundance of compassion, is doing a favor to people on Medicaid: forcing them to work or lose their coverage. “Human beings want to be treated with dignity and respect,” he says. “And we’re going to give them that opportunity.” Now all he has to do is stand back and accept their gratitude.

He shouldn’t hold his breath. In becoming the first state to impose a work requirement for Medicaid, something that needed the approval of the Trump administration, Kentucky is not likely to move many people into the dignity of paid employment. It’s more likely to move them into the indignity of doing without medical care until illness or injury forces a visit to the emergency room.

Bevin is a multimillionaire who takes a dim view of the government’s acting to ensure health insurance for everyone. “I grew up in poverty,” he says. “I grew up with no access to health care ever. I had no health care of any kind until I was an active-duty Army officer in my 20s.”

His claim of poverty is hard to square with the fact that his father worked in a wood mill and his mother in a hospital. Bevin graduated from Washington and Lee University, which had (and has) a student health clinic. When I repeatedly emailed his press aides for evidence to support his testimonial, however, I got no response.

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Sen. Jordan files personal bill to expand Medicaid

Today, on the deadline for filing personal bills in the Senate, Sen. Maryanne Jordan, D-Boise, filed a Medicaid expansion bill. “I did it because we are going to have substantive discussions this year on health care, and I think it’s important to continue to measure the cost of any new programs against the cost of a Medicaid expansion,” Jordan said. “That, and frankly it’s quite a demand from people in my district – they want to see it.”

Jordan

Jordan noted that having been introduced as a personal bill, the measure will be assigned a bill number and will be on the record and available for the public to read on the Legislature’s website. “Sometimes when you’re in a minority position, it’s a tool you can use to advance a conversation,” she said. “I don’t have any illusions of it being passed, unfortunately.”

Idaho lawmakers have refused to expand Medicaid as states have the option to do under the Affordable Care Act; 32 states plus the District of Columbia have expanded Medicaid, meaning that working poor residents can get health coverage through Medicaid, largely at the federal government’s expense. Idaho’s decision not to expand Medicaid created a healthcare coverage gap in the state under the Affordable Care Act, as an estimated 78,000 Idahoans didn’t make enough money to qualify for subsidized insurance plans through the state insurance exchange, but made too much to qualify for Idaho’s limited Medicaid program.

Gov. Butch Otter this year is proposing that the state seek two waivers from the federal government to allow a portion of that gap population – about 35,000 Idahoans whose earnings fall below the federal poverty level – to qualify for exchange subsidies, and to shift 2,500 to 3,500 of the sickest patients now covered through the exchange to Medicaid to lower costs for exchange plans.

Separately, a citizens group is gathering signatures to place an initiative on the November ballot to expand Medicaid in Idaho.


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