Category Archives: Arkansas

Medicaid Work Requirements Are Detrimental

Previous posts in this blog about Medicaid work requirements, especially in the State of Arkansas, suggested that they would be harmful to recipients of Medicaid benefits. Arkansas was the first state to implement work requirements last June.

In an exhaustive article out today from the New England Journal of Medicine, the authors found that requiring Medicaid beneficiaries to work had a detrimental effect on health insurance coverage in the initial 6 months of the policy but no significant change in employment.

Lack of awareness and confusion, the report states, about the reporting requirements were common, which may explain why thousands of persons lost coverage even though more than 95% of the target population appeared to meet the requirements or qualified for an exemption.

The conclusion of the report found that in its first 6 months, work requirements in Arkansas were associated with a significant loss of Medicaid coverage and rise in the percentage of uninsured persons.

The authors found no significant changes in employment associated with the policy, and more than 95% of persons who were targeted by the policy already met the requirement or should have been exempt.

Since the article is quite long, I have summarized the results here, but the full report can be found by clicking here.

It would appear that the goal of forcing Medicaid beneficiaries to go back to work has more downsides than upsides, but since this is being implemented by a group of puritanical, work-obsessed, economic libertarian politicians, reality has overcome their ideological disgust at giving people social benefits without expecting something in return — namely requiring low-income people to find a job in order to be covered for health care.

Isn’t it time we leave the 17th century and its puritan ethics behind and provide every American, rich or poor, with universal health care, with no strings attached? After all, that is what every other Western democracy does.

Medicaid Work Requirements in the Courts

Long-time readers of this blog will recall that I discussed Medicaid Work Requirements being proposed by the current neo-fascist regime in Washington.

This discussion was found in the following posts: Arkansas Medicaid Work Requirement Failing Out of the Gate, Nation’s First Medicaid Work Requirement Sheds Thousands From Rolls In Arkansas, Arkansas drops 3,815 more Medicaid enrollees over work requirement – Modern Healthcare, Michigan threatens to repeal Medicaid expansion if work requirements not approved | Healthcare Dive, and Medicaid Work Requirements Worsen Health,

Now comes a few new posts from several sources, that expands on the subject, especially regarding the way the courts are responding to the administration’s desire to impose draconian work requirements on what is essentially a health care program, and not a make-work program.

Note: I am awaiting enrollment into Medicaid.

The following articles all involve the Arkansas Medicaid Work Requirement case, and one judge in federal court has already decided that Congress clearly intended Medicaid to be a health program, and not a work program.

Here are the links to the articles:

Fierce Healthcare

Health Affairs Today

Center on Budget and Policy Priorities

Arkansas Times

Don McCanne commented after posting the CBPP and Arkansas Times articles as follows:

“What kind of policy is it that when low-income individuals are unable to find jobs, the state punishes them by taking away their health care? The judge hearing the Medicaid work requirement case in Arkansas agrees, “that’s not the purpose of Medicaid”

Shouldn’t we instead have a public policy that says that anyone who needs health care should be able to receive it? That is not the case now, even though we are already spending enough to guarantee health care for everyone. We could do that merely by enacting and implementing a single payer Medicare for All program, and it doesn’t have to cost us any more than we are already spending.

It would be great if our government also supported more effective policies to ensure that every capable person has employment opportunities, but depriving people of their health care is not an effective work program, as Arkansas has demonstrated.

How can it be that we even tolerate such a cruel government policy?”
Yes, how can we tolerate such a cruel government policy, when it has been government policy
decades to divide the health care system into silos, so that each demographic, the elderly, the
poor, children, families of service members, etc., are served by health care programs that are
put in silos, which no other Western nation does. Even our veterans get put into a special silo
called the VA, and that has been a disaster for our veterans seeking medical care.
We must stop playing games with people’s lives. We must also stop trying to impose outdated
work requirements reminiscent of the Puritan settlers, and does not deal with the reality of the
21st century job market that makes many poor people ineligible for the kind of employment
that would get them off of Medicaid altogether. Until that changes, we need Medicare for All,
and to stop dividing people into silos.

Arkansas drops 3,815 more Medicaid enrollees over work requirement – Modern Healthcare

Modern Healthcare reported yesterday that the State of Arkansas dropped almost 4,000 of its citizens from the Medicaid expansion because of failure to comply with work requirements the state enacted months ago.

The following summary and link is provided:

Nearly 4,000 Arkansans lost their Medicaid expansion coverage in October because they didn’t comply with the state’s new work requirement. Another 8,462 low-income adults lost benefits in the previous two months.

Source: Arkansas drops 3,815 more Medicaid enrollees over work requirement – Modern Healthcare

Nation’s First Medicaid Work Requirement Sheds Thousands From Rolls In Arkansas

Last month, you may recall, I posted an article about Medicaid work requirements in Arkansas from an article in Health Affairs.

Today, Health Affairs posted a follow-up article that reported that thousands are being shed from the Medicaid rolls in Arkansas.

According to the article, the Arkansas Department of Human Services officials announced on Sept. 12 that 4,353 people who were enrolled in the state’s Medicaid expansion program had been locked out of coverage for failing to comply with the work requirement for three months.

The agency has said those people will have until October 5 to apply for a good cause exemption if they were unable to access an online reporting portal because of network server issues that affected it and other agencies.

Source: Nation’s First Medicaid Work Requirement Sheds Thousands From Rolls In Arkansas

Michigan threatens to repeal Medicaid expansion if work requirements not approved | Healthcare Dive

Note: One more state is attempting to include work requirements for Medicaid recipients, as previously posted in Arkansas Medicaid Work Requirement Failing Out of the Gate.

 

Two JAMA studies bolster critics of work requirements who say most Medicaid recipients who are able to work are already doing so, and tracking compliance will heap more administrative burden onto an already-taxed system.

Source: Michigan threatens to repeal Medicaid expansion if work requirements not approved | Healthcare Dive

Arkansas Medicaid Work Requirement Failing Out of the Gate

Health Affairs blog published an article recently about the early experience of Medicaid recipients in Arkansas after that state implemented a work requirement in June.

Last month, I wrote an article that reported that work requirements for Medicaid worsen health.

The author of the Health Affairs article, Dr. Jessica Greene, is a Professor and the Luciano Chair of Health Care Policy at Baruch College, City University of New York. She conducted in-depth interviews with 18 adult Medicaid recipients in northeast Arkansas in mid-August.

Dr. Greene admits that the interviews are too small a group to provide generalizable results, the interviews do illustrate how the state’s policy is interacting with the day-to-day lives of Medicaid recipients to produce serious potential consequences that have little to do with policy’s stated objectives.

She outlined the results of her interviews as follows:

Lack Of Awareness

Two thirds of the Medicaid recipients (12/18) I interviewed had not heard anything about the new work requirement. “First time I’ve ever heard anything [about it],” a 31-year old man, who had started a vocational training program the day we spoke, said. “You’d think it’d be on the news or something. I ain’t seen it on the news, and I watch Channel 8 news every night.”

At Risk Of Losing Coverage

Of the nine people who, based on their age, should have received a DHS letter letting them know they were subject to the work requirement, four said they had received a letter. Two said the letters indicated they were exempt because they already met the SNAP work requirement.

The other two were at risk for losing Medicaid coverage. One, a 47-year old woman, said she had received her letter about three months earlier; she believed, incorrectly, that she had three months to report her hours. When I asked her if reporting her hours was an obstacle, she said she was struggling with very stressful life issues, including a mentally ill sister, and as a result the work requirement had not received much of her attention. The other person, a 40-year-old woman, described being overwhelmed by receiving the letter: “Basically… I’m like, okay, I’ve got this letter. I file it and I don’t know what to do with it…”

The other five who should have received a work requirement letter were either not sure if the letter arrived or thought it had not. When asked about receiving a DHS letter, a 42-year-old woman said, “I don’t know, I’m going to have to check and make sure [I didn’t receive the letter], because I need my Medicaid card for my sugar pill and my blood pressure pills.” A 46-year-old man, who had recently completed an inpatient drug treatment program, kicking a multi-decade drug addiction, wasn’t sure either. “I may have [received the letter]…I’m horrible about opening mail….I probably throw’d it away.” While the three others did not believe they received the letter, they were all exempt by either working and/or having children in the home, but likely needed to report their hours and exemptions in the portal to maintain Medicaid coverage.

Policy Not Sparking Work-Related Changes

Of the nine participants who were likely subject to the policy, only two were not meeting the 80 hour work-related activity requirement and did not seem to qualify for an exemption. Both told me that they were actively seeking work, and that the work requirement had not at all impacted their job seeking. In addition, those I interviewed between the ages of 19-29, who will be subject to the policy in 2019, either worked, went to school, and/or had children under 18 years old in the home. No one I spoke with reported that the policy had or would spark them to change their work-related activities.

Online Portal Challenging For Many

Participants described a very wide range of computer and online skills and access. Approximately a third said that reporting hours on the online portal would not be possible for them: “I can’t do that. I don’t have a phone. I don’t have a computer.”

Several, who were confident of their own skills, mentioned family members who would struggle. “Half my family probably doesn’t have a smart phone….A lot of people here don’t have internet still,” a 19-year old woman explained.

Mixed Attitudes About Linking Medicaid And Work-Related Activities

Almost all the participants believed that people who could work should be working. “I believe if you are able to work and you want the extra help that Medicaid gives, then you should work,” said a 28-year old woman who was currently working and has young children. But several expressed concern about those who had mental or physical conditions that would prevent them from meeting the requirement. One man raised questions about people who were “borderline” who were not officially considered disabled but still had serious health conditions. A 42-year-old woman, who works with people with disabilities said, “I think it’ll do more harm than good…. What they supposed to do, just get cut off Medicaid because they can’t meet those requirements?”

Others raised concerns about transportation needed to get to work and volunteering. “Some people don’t have vehicles, and sometimes it’s not necessarily their fault. Sometimes something happens and they lose their money… It’s not fair,” said a 21-year old recipient who is a college student. When I asked a woman who was looking for work whether she had tried to get help from the Department of Workforce Services, she said that she couldn’t get there because it was 30 miles away and there is no public transportation.

Not Going To Lift People Out Of Poverty

Participants were very skeptical about the Governor’s claim that the work requirement policy would help them out of poverty, as many were already working and still struggling financially.

One participant argued that the policy was not about getting people to work at all, but about reducing the number of Medicaid recipients: “It seems like a ploy for the state to save money. That’s all it is. It’s nothing about trying to get people back to work…”

Summing Up

Of the people I interviewed who were at risk of losing Medicaid coverage as a result of the work requirement, most were at risk because they lacked awareness of the policy or were overwhelmed by it, rather than because they were not meeting the 80 hours a month of work-related activities or the terms of an exemption. If this is true more broadly, the state will be ending people’s health coverage for the wrong reasons, adding credence to those who argue this policy is about reducing the rolls, rather than supporting people to get employment.

A 38-year-old woman who recently had to quit her job to get her niece, who she mothers, a birth certificate and other paperwork to start school argued that the policy does not take into account the complex lives of low-income people. “You are saying this should be possible, but you don’t know my circumstances. You haven’t been here,” she explained.

Given this limited, but anecdotal survey of the experience of 18 Medicaid recipients, it is clear that this idea is not rooted in any realistic and scientific study of how work requirements will affect Medicaid recipients, but rather is another way of getting people off the roles and moving towards eliminating Medicaid altogether, which is precisely what the Republican Party has been trying to do for decades. The war on the poor continues.

 

ARAWC Strikes Again: Opt-out Rolls On

“Just when I thought I was out… they pull me back in.”

Michael Corleone, Godfather, Part III

Source: https://www.pinterest.com/Mamzeltt/famous-movie-quotes/

When Michael confronts Connie and Neri in the kitchen of his townhouse, he warns them to never give an order to kill someone again (in this case, it was Joey Zaza), and goes on to state that when he thought he had left the mob lifestyle, they pull him back.

Thus, is the case with opt-out, as I discussed in my last post on the subject.

Kristen Beckman, in today’s Business Insurance, reminds us that opt-out, like the Mob, is pulling us back into the conversation.

As I reported last time, a bill in Arkansas, Senate Bill 653, pending in that state’s legislature’s Insurance & Commerce Committee since the beginning of March, proposes an alternative to the state system.

Ms. Beckman quotes Fred C. Bosse (not Fred C. Dobbs), the southwest region vice president of the American Insurance Association (AIA), who said that the bill is an attempt to keep the workers comp opt-out conversation going.

Mr. Bosse said that the AIA takes these bills seriously (good for them) and engages legislators to dissuade progress of such legislation the AIA believes could create an unequal benefit system for employees. (They haven’t drunk the Kool-Aid either)

Arkansas’ bill is the only legislation currently under consideration, but a state Rep in Florida, Cord Byrd (there’s a name for you), a Republican (it figures) from Jacksonville Beach, promoted legislation last year, but never filed it.

South Carolina and Tennessee, where bills were previously introduced within the past two years has gone nowhere.

And once again ARAWC rears its ugly head. For those of you unfamiliar with ARAWC, or the Association for Responsible Alternatives to Workers’ Compensation, it is a right-wing lobbying and legislation writing group based in Reston, Virginia. (see several other posts on ARAWC on this blog)

A statement ARAWC sent to BI said that these bills are beginning to pop up organically to model benefits that companies have seen from Texas’ non-subscription model. (Organically? That’s like saying mushroom clouds organically popped up over Hiroshima and Nagasaki)

Here’s a laugh for you, straight from the ARAWC statement:

Outcomes and benefits for injured workers have improved, employers are more competitive when costs are contained and taxpayers are well served by market-driven solutions,” They further said, “We recognize that each state is different and that the discussions at the state level will involve varied opinions.”

Of course, we cannot really know if injured workers are benefitting, or just being denied their rights, and it seems that opt-out is only to help employers and taxpayers get out of their responsibility to those who sustain serious injuries while employed.

In another post, the notion that Texas’ system could serve as a model for other states was outlined in a report by the Texas Public Policy Foundation (don’t you just love the names of these reactionary groups?)

Bill Minick, president of PartnerSource, praised the report, according to Ms. Beckman, and said that competition has driven down insurance premium rates and improved benefits for Texas workers. (That’s what he says, but is any of it true, I wonder? I doubt it.)

ARAWC has listed a laundry list of benefits they say responsible alternative comp laws could provide:

  • Better wage replacement
  • Reduced overall employer costs
  • Faster return to work
  • Fewer claims disputes (yeah, because they would be denied)
  • Faster claim payouts
  • Faster closure (well, when you deny claims, they can be closed faster, duh!)

It is good to know that the AIA is critical of the report, and that in their opinion, it is unworkable to allow employers to adopt a separate, but unequal system of employee benefits.

And as we have seen with the defeat of the AHCA, leaving a government-sponsored program up to market-driven forces is a recipe for disaster that should not be repeated in workers’ comp, no matter what flavor the Kool-Aid comes in.