Ohio Medicaid work rules: 5 things to know

Ohio now has approval to create work requirements for those covered by Medicaid expansion.

On Friday, U.S. Centers for Medicare and Medicaid Services granted Ohio Department of Medicaid's request to require those covered through the expansion to have a job or perform community service for at least 20 hours per week, unless given an exemption.

Here’s five things to know about the work requirements.

1. There are ways to be exempt from the requirement.

Some of the people who will be exempt include those 50 years of age or older; those “physically or mentally unfit for employment”; participants in alcohol or drug addiction treatment; caregivers for a disabled household member; pregnant women; parents or guardians of minor children; those who applied for or receiving unemployment compensation; students who go to school at least half time.

The state had estimated last year that about 95 percent of those covered by the expansion would already either meet the work requirement or be exempt. Some of the exemptions include being age 50 years or older, participating in drug or alcohol treatment, being pregnant, or complying with work requirements associated with other programs like SNAP, also known as food stamps.

The Center for Community Solutions, a Cleveland think tank, has questioned the math of how many people will lose coverage, pointing to when the state implemented work requirements for SNAP benefits. While the state estimated 134,000 recipients would be affected, nearly 400,000 Ohioans no longer receive SNAP benefits.

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2. It won’t go into effect immediately.

The Center for Community Solutions broke down the timeline for what's next over the next six months now that the state has gotten federal approval.

Ohio needs to develop and publish a comprehensive implementation plan that is due within 90 days of federal approval. This includes things like making a plan to notify enrollees about the requirements.

Within 150 days of federal approval, the state needs to develop and publish monitoring protocols and within 150 days the state needs to develop and publish its monitoring protocol.

3. This process has been going on for a year.

Ohio Medicaid said in February 2018 that it would apply for a federal wavier so it could create work requirements. The process involved several public comment periods, during which dozens of medical and social service groups pushed back against the proposal. Hospitals have credited Medicaid expansion with reducing the amount of free care they provide by expanding insurance coverage for the population they serve.

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4. This is Ohio’s first ever Medicaid work requirements.

There have never been work requirements associated Medicaid in the fifty-year history of the insurance program, which covers low income Ohioans and some people with disabilities.

President Donald Trump’s administration, however, opened the door to the creation of work requirements a year ago and 17 states so far have sought approval. Kentucky was the first to get approval. Ohio requested federal permission to create work requirements last session under the direction of the Republican-majority Ohio General Assembly.

Trump’s administration argues that if people on Medicaid work it will make them healthier and said that goal is in line with the goals of the public health insurance program.

The Medicaid expansion work requirements only affect those covered through Medicaid expansion, which started in Ohio in 2014. The state lists about 540,000 covered through Medicaid expansion as of February.

5. Work requirements in other states have faced legal challenges.

There's a pending court case that could have implications for Ohio's work requirements. U.S. District Judge James Boasberg will rule by April 1 on Medicaid work requirement programs in Kentucky and Arkansas, reported Kaiser Health News. Kentucky's's plan for work requirements is a revised version after the state's first Medicaid work requirement plan was struck down in June.

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