Medicaid Work Requirement Is A Bad Idea That Won’t Work

Recently some members of congress suggested requiring “able bodied” adults whose income makes them eligible for Medicaid should either be working, engaged in a full time job search or pursuing education that would lead to gainful employment. Such an idea may have a great appeal; but in practice it would be an administrative nightmare and will not remove many from the Medicaid rolls. 

A few years ago I wrote two columns for this publication about just who gets Medicaid in Ohio. That was based on figures before the expansion of Medicaid under the ACA or Obamacare took effect in January 2014. Prior to January 2014, it was impossible for an “able bodied” adult not caring for dependent children in their household to qualify for Medicaid. Besides caring for dependent children in the home, an adult had to be over age 65, legally blind or totally and permanently disabled with income and assets below the Medicaid eligibility limit to qualify for Medicaid. 

Examining the Medicaid population which could easily be done through a web search. The largest population on Medicaid are children under the age of 18. The next largest segment of people on Medicaid in Ohio are the disabled and elderly, many who are in nursing homes. But the expansion of Medicaid in 2014 because of the ACA opened the door of eligibility to anyone whose income and assets made them eligible.

Examining this new segment of the Medicaid population; there are few who are “able bodied” adults who are not working and in the labor force. Included in this category are many people who are already working, both part time and full time. It is just that the income from their employment is low enough to qualify them for Medicaid. Another large segment are young adults still in college or graduate school who are working toward an advanced degree and cannot qualify for health insurance any other way. 

Another segment that is now eligible for Medicaid are those adults who are acting as caregivers for a family member not a dependent child. A woman I met a few years ago fits into this category. She was forced to leave her full time job when her husband was diagnosed with cancer and her elderly father moved in with her. Caring for a sick husband and an elderly father was a full time job in itself, but did not offer any health insurance. Her husband and father had coverage through Medicare, but she was uninsured before the 2014 expansion of Medicaid. 

Another fact is that Medicaid eligibility is fluid, constantly changing as circumstances and income dictate. Someone may be eligible for Medicaid, then get a full time job where their income makes then ineligible for Medicaid. On the other side of that coin, someone may lose a job and become eligible for Medicaid. 

I know much of this from experience. I used to work at a county welfare office in another part of Ohio where a major part of my job was to determine eligibility for Medicaid. That was more than forty years ago. But currently I work among low income Medicare beneficiaries and meet many people who are on Medicaid. Determining eligibility for Medicaid includes verifying one’s income and assets to make sure that they are within the limits for Medicaid. It would be very difficult to verify whether anyone who is “able bodied” would be meeting additional work requirements. 

Short term illnesses or injuries could render someone unable to work for a few months and without income. Imposing a work requirement for Medicaid eligibility would require much more work and documentation as well as additional resources necessary to handle the appeals and other administrative costs. 

In short, the additional costs of enforcing a Medicaid work requirement may exceed the benefits gained from eliminating some people from the program. Then those people cut off from Medicaid would still need medical care and they would be uninsured. There would be the additional costs and burden on our health care facilities for more uncompensated Medical care. 

Access to health care should be a basic right of citizenship and not subject to any test of whether they “deserve it”. This is how other developed countries view access to health care, so why not the United States? If this country is to become truly great, access to basic health care should be considered as a basic right of citizenship.  

Lee Kamps

Lee has been working with Medicare, Medicaid and private health insurance since he began working at the Erie County Welfare Department in January 1973 where a major part of his job was determining eligibility for Medicaid. He went into the private insurance business in 1977 with Prudential Insurance Company and within a short time had become one of the company’s top sales agents. In 1982, he was promoted into management where he managed two field offices and as many as thirteen sales agents. After leaving Prudential in 1986, Lee decided to become more focused on health insurance and employee benefits. He has advised many local employers on how to have a more cost effective employee benefit program as well as conducted employee benefit meetings and enrollments for many area employers. The companies Lee has worked with ranged from small “mom and pop” businesses to local operations of large national companies. Lee received his B.S. degree from Kent State University where he has been active in the local alumni association. He has completed seven of the ten courses toward the Certified Employee Benefit Specialist designation. He has taught courses in employee benefits and insurance at Cleveland State University and local community colleges. In addition, Lee is an experienced and accomplished public speaker. He has been a member of Toastmasters International where he achieved the designation of “Able Toastmaster – Silver” in 1994. He has also served as a club president, Area Governor and District Public Relations Officer in Toastmasters as well as winning local speech contests. Lee has also been a member of the Greater Cleveland Growth Association’s Speaker’s Bureau where he was designated as one of the “official spokespeople for the Rock and Roll Hall of Fame” prior to the hall’s opening in 1995. He has given talks and presentations before many audiences including civic organizations, AARP chapters and many other community groups. With the implementation of the Medicare Modernization Act (Medicare drug bill) in 2006, Lee has shifted his focus to Medicare and helping Medicare beneficiaries navigate the often confusing array of choices and plans available. As an independent representative, Lee is not bound to any one specific company or plan, but he can offer a plan that suits an individual person’s needs and budget. In addition, Lee is well versed in the requirements and availability of various programs for assistance with Medicare part D as well as Medicaid. While he cannot make one eligible, he can assist in the process and steer one to where they may be able to receive assistance.

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Volume 10, Issue 2, Posted 9:45 AM, 02.05.2018