Medicaid work requirements draw provider criticism


The Biden administration objects to the House-passed proposal, a senior Centers for Medicare and Medicaid Services official told reporters last week.

“We think that the work reporting requirements—really any form of it—will simply lead to millions of folks losing coverage and primarily because of red tape, administrative bureaucracy. We don’t think that has any role in healthcare coverage,” said Daniel Tsai, CMS deputy administrator and director of the Center for Medicaid and Children’s Health Insurance Program Services.

Supporters argue work requirements would encourage people to transition off government health programs into private insurance. “The way to escape poverty and the way to have a flourishing life is to work, provide for your family and then move up the income ladder,” Angela Rachidi, senior fellow at the conservative American Enterprise Institute said during a Kaiser Family Foundation webinar April 25.

According to Census data compiled by the Kaiser Family Foundation, the vast majority of nonelderly adult Medicaid beneficiaries who don’t receive Social Security disability benefits and aren’t also enrolled in Medicare are already working or cannot work. As of March 2021, 43% had full-time jobs, 18% had part-time jobs, and the most of the remainder were caretakers, had illnesses or disabilities, or were students, the data show. Just 9% reported not working because they were retired, couldn’t find jobs or for other reasons.

Based on their experiences in 2018, the potential downsides of this policy aren’t theoretical to Arkansas providers.

Lee County Cooperative Clinic, a federally qualified health center in Marianna, Arkansas, treats a patient population that’s around 13% uninsured. When work requirements kicked in, that spiked to 22%, CEO Kellee Mitchell Farris said. Returning to that level would squeeze the community health center’s finances, she said.

“For the health centers that are still treating the patients regardless of their inability to pay, that of course affects our bottom line. We’re not able to provide all of the programs that we generally would be able to provide, if our bottom line wasn’t being affected,” Mitchell Farris said. For instance, the clinic might have to curtail the transportation services that enable its patients to make their appointments, she said.

Providers already are coping with other challenges: the aftermath of the worst stretches of the COVID-19 pandemic, the end of pandemic-era financial support and looming redeterminations of Medicaid eligibility that could remove 15 million people from the program.

Victoria Turner contributed to this story.



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