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Work requirement for Medicaid added to House bill approaching debate

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Some Medicaid benefits for the working poor could be on the chopping block under a House bill that passed earlier this year and will be debated as legislators return from summer recess.

House Bill 59, which underwent revisions in the Senate in July, also would add work requirements for people receiving Medicaid, a provision that supporters say is needed to root out unnecessary spending but that opponents decry as onerous.

In particular, the bill would “require reasonable employment and or job search requirements for those nondisabled, nonpregnant, nonelderly Medicaid eligible adults” and limit “nonessential benefits,” according to the language in the bill that was sponsored by State Rep. Dan Moul, a Republican who represents part of Adams County.

Moul said the “Welfare to work” provision is no different than what has been part of the social benefits landscape since the federal government adopted the concept under the Clinton administration. And while the bill calls for limiting “nonessential benefits,” he said, the bill does not target specific services to be eliminated. Those details would need to be worked out by the Pennsylvania Department of Human Services, Moul said.

“They can put in what they think is essential and what they think is nonessential,” he said.

Moul emphasized that the bill is intended to curb any misuse of the Medicaid system and ensure that tough decisions are being made about services in a tight budget year.

He is not certain when the next steps will happen. First, he said, the state needs to fill a more than $2 billion budget deficit. After that, “code bills” such as House Bill 59 will need to be passed, and then the various state departments would figure out the details of how to administer the new requirements. Any details about job-search requirements would be addressed through that administrative process.

Patrick Keenan, director of consumer protections and policy at the PA Health Access Network in Philadelphia, said what is intended to save money in a tight budget year could backfire on state taxpayers.

“We need a more robust conversation,” Keenan said.

The work requirement is an added layer of red tape that will further burden the state budget, while forcing people who cannot work to seek work, he said. Those who aren’t able to job hunt might drop Medicaid, which could be costly if they turn to emergency rooms for basic care or allow smaller health issues to become bigger problems, he added.

Last month, 173 organizations from across the state signed a letter asking House members to vote against final versions of the bill.

“Only 28 percent of Medicaid recipients live in households that do not have income coming from work, and only 5 percent lack employment or an exemption reason,” the letter states. “Most of those who are not working are sick, disabled, receiving treatment, attending school, retired, or providing critical care to young, sick, or elderly family members.”

“HB59 would force nearly a million adults through government hoops to verify their employment or exemptions, taxing an already overburdened system and wasting critical resources,” the letter continues.

Removing or severely limiting “nonessential benefits” such as dental care also could be costly, observers point out.

Pennsylvania is fortunate to have some dental care as part of its Medicaid program, because some states do not, said Alicia Risner-Bauman, a dentist who teaches at the Lake Erie College of Osteopathic Medicine and a member of various statewide dental groups.

Studies have shown that the lack of basic care can lead to serious and expensive problems later. Someone with an infected tooth will go to the emergency room or their primary-care doctor, who will simply tell them to go see a dentist, she said.

That is where any initial cost savings by limiting services could be lost, she added. She advocates increasing coverage of dental care as a way to further curb overall spending with health care.

“If they (decision makers) put more money into dental, it will decrease the need for medical later,” she said.

The Department of Human Services declined to comment on its plans for dental care, stating that it is in an appeal process involving the implementation of the state’s Medicaid insurance system.

Helen Hawkey, executive director of the PA Coalition for Oral Health, said people sometimes don’t see the connections between paying for prevention on the front end and the heavier burden on the back end for treating severe but avoidable problems.

That debate is what will play out this fall, she said.

Risner-Bauman agreed, saying no one really disagrees with the logic about preventive care.

“We don’t really have anyone fighting us,” she said. “But the issue is always money and budget.”

Moul said no one wants to see a service such as dental insurance completely cut out but that everything needs to be reviewed to make sure taxpayers aren’t paying for more than they need to fund.

“I don’t think that (cutting dental care completely) is what anyone wants to see where it goes,” Moul said. “But what is necessary and what is not? We want healthy people. It is always better to take care of healthy people before they get sick.”

Pennsylvania might need to get closer to the basic care allowed by the federal government and review where the state has added benefits and then cut or limit those benefits, he added.

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