Category: MM Curator

[MM Curator Summary]: The author suggests that the success of welfare reform- which got single mothers into the workforce- should be considered before we burn the Republican witches at the stake.

“Work requirements” are back in the news, after a federal judge ruled in favor of Georgia’s Medicaid “waiver.” It’s worth exploring what this means — and what it doesn’t.

You may recall this discussion from years past. Rather than expanding Medicaid as envisioned by Obamacare, Gov. Brian Kemp sought and received federal permission for a more limited expansion, including a work requirement. But within days of Joe Biden entering the White House, the federal government signaled it would rescind that approval, which it did late last year.

First things first: “work requirements” is a misnomer. In fact, the Georgia Pathways program offers several ways to meet the 80-hours-per-month qualification. Those include a job, job training, community service and some types of education.

But to the extent “work requirements” are fulfilled by actual work, they’re a proven way to help Americans better themselves financially. We can see this from the successful welfare reforms of the 1990s.

A 2016 study of the effects of the reforms by the Manhattan Institute found child poverty, for example, fell from 29% in 1993 — exactly where it stood back in 1967 — to 18% in 2000 and 17% in 2009. Even after the Great Recession, it was significantly lower than pre-reform, at 19% in 2012.

What changed? Single mothers joined the workforce. Before, they faced a choice between working and receiving benefits — a choice that skewed toward welfare because of the relatively high wages one would have to earn to replace those benefits. With greater latitude to work, single mothers began working at much higher rates: a 15-percentage-point increase between 1996 and 1999, compared with a 10-point increase between 1980 and 1996. The share of single mothers on welfare fell from 50% in 1996 to 17% in 2008.

How does that apply to Medicaid? It largely hasn’t. Courts ruled that adding work requirements for existing recipients in Arkansas and Kentucky was unlawful because it would cost some people their coverage. Opponents of Georgia’s waiver pointed to those rulings as a reason Kemp was wasting his time.

But Kemp’s program, called Georgia Pathways, essentially reverse-engineered the Arkansas and Kentucky rulings. Rather than adding work requirements for current beneficiaries, Georgia uses “qualifying activities” to determine eligibility for the new program. People can’t lose coverage they never had.

Thus, Georgia Pathways can only increase coverage. That was central to the Aug. 19 decision by U.S. District Judge Lisa Godbey Wood, which set aside the Biden administration’s rescission of Georgia’s waiver.

Pending an appeal by CMS, we may finally get to see how work requirements fit with Medicaid. We can expect good things.

First and foremost, we can expect better health outcomes for recipients — even if federal judges have said health outcomes aren’t a priority for Medicaid waivers, because coverage is the program’s central objective. Why better outcomes? Research indicates employed people tend to remain healthier. Even if that isn’t a primary objective of Medicaid, it would be a worthy result.

Georgia Pathways also prioritizes private coverage for workers whose employers offer health insurance. That’s beneficial for them in two key ways. First, private insurance is much more widely accepted by providers than traditional Medicaid, so these workers are far more likely to gain access to care.

Then there’s continuity of coverage. The income limit for Georgia Pathways is 100% of the federal poverty line, or $13,590 for a single adult this year. A part-time worker earning $13.50 per hour would barely qualify. But if he got an hourly raise of even 10 cents, he might lose it.

With traditional Medicaid, that would mean losing his specific plan, with its specific network of doctors. But with Georgia Pathways, he would already be on his employer’s plan. Although he would have to pay more in premiums, he could stay on the same plan and keep the same doctors.

All of this is more complicated than our bumper-sticker politics prefers. But it’s clear that with this ruling, Georgians may finally get a plan that works.

Clipped from: https://thebrunswicknews.com/opinion/editorial_columns/medicaid-work-requirements-arent-inherently-a-bad-thing/article_809114f7-f637-51ec-96da-48b291302c98.html

[MM Curator Summary]: Ruh-roh.

Photo: VisionsofAmerica/Joe Sohm/Getty Images

A federal judge has reinstated a Medicaid work requirement program in Georgia, saying that the Centers for Medicare and Medicaid Services, under the Biden administration, unfairly struck down the program that was first approved by the Trump administration.

CMS said last year it was revoking the work requirement, as well as a proposal to charge some Medicaid recipients monthly premiums. That prompted Georgia officials to sue, saying the agency lacked the authority to rescind the provision.

U.S. District Judge Lisa Godbey Wood issued the ruling on Friday, saying CMS’ decision was “arbitrary and capricious.” She said the agency measured pathways against a baseline of full Medicaid expansion rather than taking the demonstration on its own terms.

Wood also said CMS violated federal law by not engaging in reasoned decision-making, and failed to adequately explain why it changed course from the previous administration’s approval. She added that rescinding the approval may mean less Medicaid coverage in the state.

CMS does not comment on litigation as a matter of policy, but said last year that similar work requirements in other states had created confusion and hardship for Medicaid beneficiaries, with more than 18,000 losing coverage in Arkansas upon implementation of that state’s work program.

Georgia’s plan was to add an estimated 50,000 low-income and uninsured residents to the Medicaid rolls within two years, with the requirement that new Medicaid recipients would need a minimum number of qualifying hours through work, job training, education or volunteering.

Georgia Democrats have said full Medicaid expansion would cover hundreds of thousands of people at a much lower cost to the state, owing to expansion options under the Affordable Care Act, with the federal government picking up 90% of the cost of expanding the program to adults who make up to 138% of the federal poverty level.

In a recent Tweet, Georgia Governor Brian Kemp said the state’s plan “would better serve Georgians than a one-size-fits all Medicaid expansion.”

WHAT’S THE IMPACT

CMS began implementing work requirements for Medicaid coverage four years ago, a move opposed by those who said it would kick many receiving coverage off of Medicaid’s rolls.

In order to qualify for the program, individuals must comply with specific requirements, including participating in 80 hours of work monthly, or other qualifying activities. Most people with income between 50% and 100% of the FPL would be required to make initial and ongoing monthly premium payments.

Applicants and beneficiaries with disabilities who require reasonable accommodation will have options available to complete and report their qualifying activities and hours. The state is providing support to those not already working in order to encourage and enable those beneficiaries to obtain employment and take part in other education and job-supporting activities.

THE LARGER TREND

The Biden administration first began taking steps to roll back Medicaid work requirements in 2021, citing the economic and health impacts of the COVID-19 pandemic, which it said could make it more difficult for Medicaid recipients to fulfill the requirements.

“Uncertainty regarding the current crisis and the pandemic’s aftermath, and the potential impact on economic opportunities (including job skills training and other activities used to satisfy community engagement requirements, i.e., work and other similar activities), access to transportation and to affordable child care have greatly increased the risk that implementation of the community engagement requirement approved in this demonstration will result in unintended coverage loss,” CMS said in letters to states at the time.

Hospitals in states that implement Medicaid work requirements could see their Medicaid revenues decrease by as much as 21%, their uncompensated care costs increase as much as 133% and their operating margins fall by upward of 2%, according to estimates by The Commonwealth Fund.

Twitter: @JELagasse
Email the writer: je**********@********ia.com

Clipped from: https://www.healthcarefinancenews.com/news/federal-judge-reinstates-georgia-medicaid-work-requirements

In issuing the ruling, U.S. District Judge Lisa Godbey Wood said CMS’ decision was “arbitrary and capricious.”