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Medicaid work rules inspire battle

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After new guidelines were unveiled by the federal government, Pennsylvanians should expect to buckle in for a rerun of the fight over whether people receiving Medicaid should be required to work.

Back in October, Gov. Tom Wolf vetoed a bill that would have required able-bodied adult Medicaid recipients to show proof of 20 hours a week of employment, a search for employment, or job training.

The debate seemed largely settled until January, when the federal Centers for Medicare and Medicaid Services unveiled new guidelines for states hoping to adopt work requirements. The new rules allow states to apply for a waiver to implement “community engagement” requirements for able-bodied recipients of health insurance through their state’s Medicaid programs, making exemptions for those with roadblocks to employment.

Now, a new bill introduced by Rep. Seth Grove (R) of York County could revive the requirements just as a primary race among bidders to unseat Wolf is picking up steam.

Grove, who called the governor’s fall veto “very short-sighted” while citing the growing budget of the program, suggested the new federal guidelines present “another attempt at encouraging those who can be employed to contribute to society and the economy on a whole through work.”

Grove did not respond to multiple requests for comment. His bill, HB 2024, is currently in the health committee.

The requirements proposed by Grove mirror similar rules enacted in Kentucky and Indiana, with eight other states waiting on final approval by the Centers for Medicare and Medicaid Services, also known as CMS. The work requirements have generally been accompanied by other new requirements

In Kentucky, for example, people deemed jobless and fit for work must take and pass a health literacy test if they wish to continue coverage. In Indiana, the work requirement comes on the heels of news that 25,000 of the state’s Medicaid recipients were cut from the program for failure to pay premiums enacted by the state in 2015.

State Sen. Scott Wagner, the odds-on favorite to win the PA GOP nomination for governor, voiced his strong support for a work requirement.

“If the goal is to keep more Pennsylvanians in a cycle of poverty and government dependence, then by all means keep the status quo,” said Wagner. “But if you want able-bodied men and women to have the satisfaction of bringing home a paycheck, then we need to look at instituting some form of work and job-search or training requirements based on the success realized in other states through similar programs.”

Advocates and officials are worried the new rules, if implemented, put up barriers to people getting health care.

So said Teresa Miller, acting secretary of the Department of Human Services which oversees the state’s Medicaid program. Formerly the state’s insurance commissioner, Miller was nominated by Wolf last March to lead a proposed Department of Health and Human Services. The new department, not yet formed, would consolidate the current departments of Human Services, Health, Aging, and Drug and Alcohol Programs.

For many Medicaid recipients, said Miller, finding and keeping a job is more complicated than proponents for the requirements would suggest.

“I think we need to do everything we can to get everyone who’s able to work to work. But I think the problem is, even though individuals may be identified as able-bodied, they still face barriers to employment,” said Miller.

If implemented, the guidelines developed by CMS, if implemented, could result in a loss of health care access among people who are mentally disabled, lack affordable child care or education, or are fighting an opioid addiction, said Miller, pointing out the state currently has 236,000 Medicaid recipients diagnosed with substance-use disorders.

“You take an individual like that and removing their health care coverage in the midst of this epidemic, I think it would be a big step backwards,” said Miller.

The CMS guidelines encourage states to include an exemption from the work requirements to those in addiction-recovery programs, and the bill sponsored by Rep. Grove would allow for such exemptions. The bill also exempts recent victims of domestic violence, pregnant women and those receiving long-term disability benefits from Social Security.

Secretary Miller pointed out the majority of Medicaid recipients already work, claiming 58 percent employment rate among the program’s beneficiaries, and those that don’t work face barriers like those excluded from the requirements by CMS and Grove’s legislation.

The population that would be affected by the guidelines is so small, said Miller, the work requirements would necessitate more government than they would eliminate and possibly deny coverage to people who should rightfully be exempted from the work requirements.

“Most people are working. So given that, we’re talking about a relatively small population. And we’re going to create a whole bureaucracy to follow that population and check a box whether they’re working or not?” said Miller.

Still, work requirements are generally popular among voters. According to a poll released by The Commonwealth Foundation, a Harrisburg-based conservative think tank, over two-thirds of Pennsylvanians support a work requirement for Medicaid recipients.

In a statement released with the survey, director of policy analysis for the foundation Elizabeth Stelle urged lawmakers to follow voters’ lead.

“We must not let people languish in a broken system because we lack the political will to fix it,” Stelle said. “Lawmakers and the governor must recognize that promoting work is key to ending generational poverty and preserving resources for those who need them most.”

Miller attributes the popularity of the guidelines to a misunderstanding of what keeps people from working.

“I think on its face it sounds like a good idea to have people on Medicaid working, and I don’t think we disagree with that at all, “ said Miller. “There’s more agreement here than people want to see.”

Differences over the requirements are a matter of philosophy: a choice between prioritizing work for its own sake, or identifying and dismantling the barriers that keep people from working

Miller hopes it’s the latter. “It’s really just a question of do we want to take an approach that penalizes people who aren’t working, or do we want to take an approach that says we know we’ve got folks who are technically able-bodied but aren’t working. So let’s look at the population and see what’s keeping them from working and what barriers they’re facing and addressing them.”

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