The Alabama Medicaid Agency wants to require some able-bodied parents, who make up a small slice of the state’s Medicaid rolls, to work, attend school or a job training program or do volunteer work.
Medicaid has applied to the federal Centers for Medicare and Medicaid Services for a waiver to impose the requirement and will hold public hearings on the plan in Montgomery and Hoover next week.
Ivey said the plan will save taxpayer dollars and reserve Medicaid services for those that need them most.
“The Alabama Medicaid Agency is working hard to be good stewards of limited resources while also keeping to the original Medicaid program design,” Ivey said in a statement today. “This week’s formal move is the result of a process that began in October 2017 and is a continuation of my effort to ensure state government is effective, efficient and managed in accord with our conservative principles.”
Jim Carnes, policy director for Alabama Arise, which advocates for low-income families, said the proposal is mean-spirited and misguided.
Carnes said parents who follow the rules and get jobs will lose their Medicaid coverage and won’t have a realistic alternative. He said the state will take on significant new administrative costs to implement and monitor the new requirements and various exemptions.
“It’s kind of mind-boggling how ill-conceived this is and what a cruel plan it is,” Carnes said.
Medicaid is a joint federal-state program that provides health care coverage to the poor, disabled and elderly. About one million people in Alabama get some form of Medicaid coverage, and more than half of those are children. The federal government pays about 70 percent of the cost but the state share includes the largest appropriation from the General Fund for any agency.
Able-bodied parents with children under 19 can qualify for Medicaid if they have very low incomes, no more than 18 percent of the federal poverty level. To be eligible, for example, the monthly income cap for a family of four is $377. Adults who take care of a closely related child under 19 can also qualify for Medicaid under the same category, called Parents or Caretaker Relatives.
As of January, about 75,000 adults qualified for Medicaid under the program statewide, about 7.5 percent of the state’s Medicaid recipients.
The new work requirement would apply to some of the 75,000 but some would be exempt, including those with a disability or medical frailty, those 60 or older, those taking care of a disabled child or adult, pregnant women and others.
The work requirements would be similar to those the Alabama Department of Human Resources has for recipients of Temporary Assistance to Needy Families, which is the cash welfare program.
“Alabama Medicaid believes that increasing employment among parents and caretakers through employment and job training requirements will improve health outcomes and economic security among this population and their families,” the public notice from Medicaid says.
Medicaid is requesting a waiver for a five-year demonstration project to test whether the requirement will move people off Medicaid and into the workforce and private health insurance coverage.
Carnes said he doesn’t believe the program would achieve its announced intent.
“It’s a very cynical policy that frankly is not very well thought out,” Carnes said.
For example, Carnes noted that the income cap to receive Medicaid under the Parents or Caretaker Relatives Category is $312 a month for a mother with two children at home. If the mother starts work, even at a minimum wage job, she would exceed the cap. Under Medicaid’s waiver proposal, she would be able to keep her Medicaid coverage for a six-month transition period after exceeding the income cap.
But after that period, Carnes said many would be unable to buy private health insurance, mainly because the premium tax credits under the Affordable Care Act aren’t available to those earning less than the federal poverty level. That’s $25,100 for a family of four, more than what many leaving the Medicaid rolls could expect to earn, Carnes said.
“After the six-month period there is no where for them to go,” Carnes said.
“These are the poorest of the poor,” Carnes said. “And one of the things they rely on in those meager circumstances is Medicaid coverage for their health care. So that’s an asset that they have. And we’re threatening to take it away.”
Carnes said work requirements made more sense in states that expanded Medicaid coverage to cover low-income working adults under the Affordable Care Act. But Alabama did not.
The first public hearing will be Monday at 11 a.m. at the Alabama Industrial Development and Training auditorium in Montgomery. The address is One Technology Court.
The second public hearing will be Tuesday at 11 a.m. at the Hoover Public Library, 200 Municipal Drive.
Medicaid will provide teleconference access for the meeting in Montgomery. Medicaid is accepting public comments on the proposal by email until April 2. More information can be found on the Medicaid website.