If the Trump Administration and some state officials have their way, hundreds of thousands of low-income people could be kicked off Medicaid and left without any health insurance coverage. That’s because several states are pushing to add harsh work requirements to Medicaid assistance. We’ve written in the past and compiled a lot of resources showing why work requirements are not only bad public policy, but actually a Trojan horse for kicking people off programs such as Medicaid and SNAP, and “saving” considerable dollars by ending aid to people who need it. Here’s an opportunity to weigh in and help stop huge numbers of people from losing their health care.
Right now, Kentucky and Mississippi are among the states seeking federal waivers to add numerous regulations and roadblocks to the states’ Medicaid programs, including harsh work requirements and other barriers to coverage and care. The Department of Health and Human Services (HHS) is accepting comments through August 18 on the proposals in these states, and CHN has made it easy to act with step-by-step instructions and template comments.

Kentucky has estimated that 95,000 people will be removed from its Medicaid program if its proposal takes effect. Mississippi predicts that nearly 5,000 Medicaid recipients in its state will lose healthcare coverage during the first year of the proposed Medicaid work requirement. A federal judge has already ruled that Kentucky’s waiver could not be approved, because HHS hadn’t taken into account the likelihood that their policies would run counter to Medicaid’s purpose of providing health care to low-income people. But that hasn’t stopped Kentucky officials or HHS Secretary Alex Azar – he has reopened the comment period in the hopes of getting more comments that favor work requirements.

In Mississippi – a state the hasn’t expanded Medicaid – the work requirements would set up a classic Catch-22. Parents in the state can only qualify for Medicaid if their income is less than 27 percent of the poverty line. So for those very low-income parents who don’t meet the work requirement, they lose their Medicaid coverage. But if parents do work enough to meet the 80-hour per month requirement, they will eventually lose Medicaid too, because they will earn too much to qualify. (Mississippi will allow these parents up to two years of Transitional Medicaid, but when that runs out, there is no realistic replacement.) As the Center on Budget and Policy Priorities points out, working parents could end up uninsured for either of two reasons: first, few low-wage jobs (especially part-time jobs) offer coverage; and, second, with incomes below the poverty line, they wouldn’t qualify for subsidized coverage in the Affordable Care Act’s individual insurance marketplace, where people’s incomes need to reach 100 percent of the poverty line in order to get subsidies.

Further, neither state proposal increases funding for child care to help parents find and keep the jobs they would be required to hold. In fact, the federal Medicaid work requirements guidance document indicates that federal Medicaid funds may not be used for child care, employment services, transportation, or other supports. The new monthly documentation requirements themselves may also cause people to lose coverage, even if they are working the required number of hours. Again, this is the Trojan horse – while supporters of work requirements may say the purpose of them is to get people back to work, we know that these proposals are really just a way to push people off programs that help provide basic living standards, in part to pay for things like the bill Congress passed last December to give massive tax cuts to the wealthy and corporations. Unless needed supports are provided to help people find and keep good jobs, the result will be fewer people with health insurance and more adults and children harmed.

CHN has written step-by-step instructions and template comments that organizations and individuals can use to submit comments about the Kentucky and Mississippi proposals. Click here to act before Saturday, August 18 at 11:00 p.m. ET. The outcomes in these states could have national implications.  Comments help shape judges’ decisions, as they did in the Kentucky case. They are still needed.

Access to medical care is critical to keeping people healthy, which allows them to work as they are able. To learn more about Medicaid work requirement proposals being tracked in the states, click here. For statements, infographics and other resources related to work requirements, check out CHN’s Protecting Basic Needs Programs webpage.