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Capitol Correspondence - 11.19.18

Governors of States with Newly Expanded Medicaid Weigh Work Requirements

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ANCOR is sharing the article below by Politico Pro because of our concerns that Medicaid work requirements can affect people with I/DD. These concerns are also shared by the Center for Budget and Policy Priorities (CBPP).

As shared by Politico Pro:

“Republican officials in red states where voters recently approved Medicaid expansion are exploring adding work requirements and other conservative policies that could limit enrollment.

Changes encouraged by the Trump administration could make it easier for Republican officials in those states to accept Medicaid expansion after years of resisting the program. The ballot measures easily approved last week in Idaho, Nebraska and Utah didn’t specifically forbid the states from adding conditions to Medicaid expansion, but some of the measures’ backers are threatening to fight new limits in court.

In the very least, a push to add conservative elements to Medicaid expansion could rekindle a fight over health coverage for the poor, even after voters just approved new benefits for roughly 300,000 low-income adults.

In Idaho, Gov.-elect Brad Little didn’t oppose the ballot measure, but he has suggested the state would look at work requirements if the referendum passed.

‘We need to make sure that people that get into the Medicaid field, that there’s incentives for them to go to work full time,’ Little said in October.

Idaho state Sen. Brent Hill, a member of GOP leadership, said lawmakers are discussing ‘five or six ideas’ for conservative policies that could be attached to Medicaid expansion, including a work requirement and enrollee asset tests.

The Trump administration has made Medicaid work rules a centerpiece of its agenda to overhaul the social safety net, approving waivers allowing four states to impose employment conditions on able-bodied adults. Other states are awaiting approval, while Arkansas and Kentucky are facing legal battles over their requirements. More than 8,000 people have already been dropped from Arkansas’ rolls.

In Utah, state Rep. Jim Dunnigan, who previously helped craft a much smaller coverage expansion for the chronically homeless, said he supports a work requirement for the Obamacare expansion.

‘It’s possible that it could be modified to be more of a Utah format than just the typical Obamacare expansion,’ Dunnigan said.

Supporters of the ballot initiatives are cautioning state officials against making changes that could curtail or delay enrollment.

‘We would fight it,’ said Matt Slonaker, executive director of the Utah Health Policy Project. That could include going to court to block them, he said.

‘This was a very clear message’ that voters supported expanding coverage under the terms of the health care law, said RyLee Curtis, campaign manager of the Utah ballot effort.

Republican officials in the three new expansion states haven’t threatened to block the program entirely, decreasing the chances those states could have similar legal fights to the one playing out in Maine. Republican Gov. Paul LePage, in his final year in office, has blocked implementation of Medicaid expansion approved by Maine voters in 2017.

The fight over conservative changes to the program could happen when legislatures figure out how to fund it. Lawmakers in Nebraska and Idaho starting early next year will have to address outstanding issues like how to finance their states’ share of the program’s costs. Utah’s ballot measure included a small boost in the state’s sales tax to help pay for Medicaid expansion.

States cover a small but gradually increasing portion of costs, which eventually settle at 10 percent.

Still, work requirements may not be a given in Nebraska. Legislature Speaker Jim Scheer said he’s not pushing for employment conditions.

‘I don’t have a strong feeling that that’s something that would be necessary,’ he said.”