Ohio’s plan to add work requirements for Medicaid gets push back

Supporters say able-bodied people should be working.

Dozens of medical and social service lobbying groups are pushing back against Ohio Medicaid’s request to create work requirements for able-bodied adults covered through Medicaid expansion.

The Trump administration opened the door for states to add the first-ever work requirements associated with the state-federal health insurance program for the poor. In response, the Republican-dominated legislature inserted language in last summer’s budget bill ordering the Kasich administration to apply.

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The state estimates that a little more than 5 percent of the 700,000 Ohioans on expanded Medicaid — or about 36,000 people — would risk losing their health insurance under the proposal. The rest are already working or are exempt from the requirement because of their age, disability, care-taking responsibilities or other factors.

The proposed rules would require beneficiaries to either have a job for at least 20 hours per week, be looking for work, or attending school or job training.

The requests to add work requirements have sparked debate over whether the conditions are necessary to push people toward jobs and out of poverty, or whether the new rules will put unnecessary burdens on the poor and make health outcomes worse.

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Ohio Medicaid says it is reviewing all comments and will prepare a final proposal to be submitted to U.S. Centers for Medicare and Medicaid. The federal government will then hold its own public comment and review period before making a decision.

‘If you’re an able-bodied person you should be working’

The Buckeye Institute, a conservative leaning think tank, submitted one of the few public comments in support of the proposal.

Rea Hederman, Buckeye Institute Vice President for Policy, said one of the negative results of Medicaid expansion — which was made possible by the Affordable Care Act — has been taking able-bodied people out of the labor force. Kasich, a Republican in his last year as governor, fought hard for Medicaid expansion and has advocated for continuing the program after he leaves office.

Hederman argued that entitlement programs like expanded Medicaid have moved away from just covering the truly needy.

“It’s long been part of the American ethos that if you’re an able-bodied person, you should be working,” he said.

Most comments: Don’t do this

The other hundreds of comments submitted to the state were mostly critical of the plan.

Universal Health Care Action Network of Ohio, a consumer advocacy group, said work requirements run against the purpose of Medicaid.

Steve Wagner, the group’s executive director, said it’s not in Ohio’s best interest to make it harder for people to afford preventive care, and will result in more emergency room visits that are costly and lead to higher health care costs for everyone.

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“If you really want people to have employment, you need to create the capability for them to work,” Wagner said.

The Ohio Hospital Association said Ohio Medicaid should take steps to make sure that documenting eligibility doesn’t become a barrier to coverage.

“We encourage the state to make all possible effort to work with individuals who are not otherwise deemed to be exempt or already meeting the Work and Community Engagement Requirement to ensure that they have the tools and supports they need to comply,” Mike Abrams, president and CEO of the Ohio Hospital Association, said in an emailed comment.

More exemptions sought

Multiple commentators said people leaving prison or jail should be exempted from the requirements, arguing they often face barriers to employment and need the support the Medicaid program provides for a successful re-entry.

Other groups said foster youth aging out of the system should be exempted, allowing them to get a head start on what is often a difficult transition.

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Geoffrey Collver, associate director with The Ohio Council of Behavioral Health & Family Services Providers, said his organization has serious concerns that the work requirements would disproportionately affect people with behavioral health conditions. Some among that population lack a permanent address or transportation, or may have trouble finding work because of a criminal conviction, he said.

“All of these factors add to the myriad challenges that people with behavioral health conditions face when confronted with an already complicated eligibility system,” he said.

Several organizations, including Ohio Association of Community Health Centers, submitted concerns over how a person will be deemed “physically or medically unfit” for work, which is one of the exemptions under Ohio Medicaid’s proposal.

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The work requirements are intended to reduce costs and increase personal responsibility by pushing more of the 36,000 affected individuals into jobs and away from public assistance. But in verbal testimony to Ohio Medicaid, the Ohio Public Health Association’s Anita Carter questioned whether that will happen.

“Most of those among that 36,000 are hardest to employ,” she stated.


PREVIOUSLY: Ohio wants federal approval to add job requirements for those covered through Medicaid expansion.

WHAT'S NEW: The state is reviewing the hundreds of public statements submitted about the proposed work requirements, including dozens from different medical associations against the pending rule changes.

WHAT'S NEXT: The final work rules will be submitted to U.S. Centers for Medicare and Medicaid, which will also gather public comment and then issue a decision.

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