Work requirements for Medicaid recipients draws debate

Ohioans 55 or older, or those with a substance use disorder or other intensive health need, would be exempt from the work requirement.

“They don’t have a disability,” State Sen. Steve Huffman, R-Tipp City, said. “...They have the ability to get a job.”

The proposed work requirement for Medicaid expansion members was included in the state budget two years ago, Huffman said. Lawmakers are requiring the Ohio Department of Medicaid to submit this proposal to the federal level.

“They have done it for other states, and it is only for the expansion population,” Huffman said.

In 2019, the U.S. Centers for Medicare and Medicaid Services under the Trump administration approved Ohio’s request to make the changes. Those changes were put on pause due to the COVID-19 pandemic before the Biden administration withdrew support for the requirements in 2021.

A loss of Medicaid dollars

Some people said reducing the number covered under Medicaid could impact local economies and how much federal funding the state receives.

“Healthy people are productive people, and a productive population makes both a thriving economy and a better state reputation via a happier society,” said Kathryn Kosey of Dayton. “The proposed work requirements would make it more difficult for people already struggling to stay productive to access Medicaid by adding huge administrative burdens to being enrolled in the program.”

One response said Medicaid is an economic driver, so reducing the number of members covered under the program also reduce use of the wider range of health care industries in the area, while potentially increasing use to emergency care, filling up local emergency rooms.

“Medicaid dollars flow directly into local communities, supporting health care providers, hospitals and related industries,” said Dan Mistak, who is the acting president and director of Health Care Initiatives for Justice-Involved Populations at Community Oriented Correctional Health Services.

If Medicaid also switches to a per capita funding model in the future, this could impact the amount of funding the state receives if Ohio has fewer Medicaid members.

“Implementing work requirements is particularly short-sighted given renewed discussions at the federal level about transitioning Medicaid to a per capita cap funding model,” Mistak said.

If such a policy is adopted, states like Ohio would benefit from having as many people as possible enrolled in Medicaid to secure higher federal funding levels, he said.

“By removing individuals from Medicaid rolls now, Ohio risks permanently reducing its baseline enrollment figures, which would result in less federal funding and greater financial strain on the state in the future,” Mistak said.

Failing to address root causes

Others said this requirement could penalize people who are already struggling.

“My work as a social worker and as an attorney in the child abuse and neglect unit at the prosecutor’s office clearly saw that work requirements disproportionately harm vulnerable populations such as individuals with disabilities, mental health conditions, people in rural communities and low-wage workers with irregular schedule,” said Jennifer M. Allen, counselor at law at Williams Allen Casey LPA.

“Based on experience with similar policies in other states, we fear these requirements will lead thousands of people to lose coverage and jeopardize the health care of people with CF (cystic fibrosis) and other serious and chronic conditions,” said Amanda Attiya, state policy specialist at the Cystic Fibrosis Foundation.

In the Appalachian region of Ohio, advocates felt this would disproportionately impact those residents.

“Mandatory work requirements for Medicaid eligibility risk increasing the number of uninsured individuals while failing to address the root causes of poverty and unemployment. Instead of helping people transition out of poverty, these policies will exacerbate existing challenges faced by vulnerable populations,” said Megan Riddlebarger, executive director of Corporation for Ohio Appalachian Development.

Others worry these requirements may cause people to fall through the cracks.

“There are ways to help people out of poverty, but restricting their access to health care will only make their situation worse. The homeless and people in domestic violence situations are just two examples that come to mind,” said Mary Sue Gmeiner, of Dayton.

Few show support of proposed requirement

Out of the more than 400 responses to Ohio Medicaid, most were against the proposed requirements, but a few of the comments received were in favor of them.

“I strongly support work requirements for Medicaid. Work provides value to a person’s life and enhances family dynamics,” said Ruth Pettitt.

“There are so many people that abuse the system,” an anonymous person said. “If it was put to public vote, I would definitely support it.”

Of those who showed support, many said it seemed like a reasonable to request to them.

“As someone who worked their entire life, I believe that it is more than reasonable to require all able-bodied persons younger than 55 to work 20 hours a week in order to receive Medicaid benefits,” said Christy Mosier, of Newcomerstown. “...I do believe that all people, especially children, should have access to affordable health care. However, when did it become wrong to expect an able bodied person to work for the money and benefits they receive?”

“As a health care worker, I see the abuse daily as non-working adults freeload off the system while treating health care workers with disdain. Please require adults to work for their health care like the rest of us,” another anonymous person said.

Others were not against able-bodied people being required to work, but questioned if this might impact people who are not working because they are someone’s caregiver.

“While I wholeheartedly believe able-bodied persons should work, I am concerned about those who are a child’s primary caregiver. With the cost of child care, I do not believe this is good policy to take away the healthcare of a parent who is home with their child,” said Rebecca Wolfe, of Dublin.

Lawmakers are requiring the Ohio Department of Medicaid to submit this request to the U.S. Centers for Medicare and Medicaid by Saturday, according to House Bill 33 passed by the 135th Ohio General Assembly.

More information

Under the proposed requirement that Medicaid expansion members have to be working, in school or in occupational training, there will be no regular reporting by enrollees, according to Ohio Medicaid. Some of the data that will be used to determine work, schooling or disability status will include: