While the rest of the country wrestles with the ideal of making people who receive Medicaid work or lose their benefits, the concept is not new in Kansas. It’s just KANCARE 2.0, a revision to Kansas’ privatized Medicaid that Gov. Brownback has been trying to implement since last year.
However, the idea of having individuals work or get thrown of Medicaid – the insurance program for Americans poor — gained major support with Trump administration announcing a plan to allow states to impose work requirements on Medicaid recipients.
Brownback was ahead of the bunch, he submitted his plan for KANCARE 2.0 to the Centers for Medicare & Medicaid Services (CMS) in late December. His program proposes a work requirement as well as a lifetime cap on benefits for some low-income recipients.
The Obama administration had not approved any state waivers that would impose work mandates, saying it was not in keeping with the program’s mission to provide access to medical services. The Trump administration swiftly signaled that it held a different view. Shortly after taking office in March, CMS Administrator Seema Verma, sent a letter to governors urging them to apply for such waivers.
The historic move would be a significant change in how the government health insurance program operates currently, but it would fulfill a longtime Republican goal.
In a guidance released last week, CMS pointed to studies that show working and volunteering can contribute to better health as justification that the requirement is in keeping with Medicaid’s mission.
Leonardo Cuello, health policy director of the National Health Law Program. He dismissed the agency’s justification that unemployment makes people less healthy. Instead he supports Obama and previous administration philosophy that requiring recipients to work would be illegal because it is not consistent with Medicaid’s objectives.
“Working doesn’t make people healthy. It’s making people healthier that enables them to work,” he said. Taking away people’s access to health care is a “terrible strategy if you want to promote work.
The CMS guidance also outlined what states need to include as part of a program that mandates Medicaid enrollees to work in order to qualify for benefits. States, for instance, could require non-disabled, working age recipients to work, volunteer, go to school or enter a job training program. The guidance also includes caregiving as one of the activities.
The agency’s guidance provides states with a lot of flexibility in designing their programs and highlights that many recipients may need additional considerations.
For instance, the guidance notes that some Medicaid recipients may have trouble meeting work requirements because of poor health, substance abuse or high unemployment in their areas. States should take these issues — as well as recipients’ employability — into consideration and allow for modifications or exemptions, the agency said. Pregnant women will also be exempt.
The agency specifically calls out the opioid epidemic, saying that time spent in treatment can count towards the mandate and those in intensive recovery programs can be excused. Many governors, including Republican ones, have defended the Medicaid program as being critical to addressing the substance abuse crisis.
Critics argue that Republicans are using work requirements to thin the Medicaid rolls.
“This is nothing but yet another excuse for Republicans to try to kick people off of their health insurance, and more than 393,000 Kansans who rely on Medicaid are at risk,” wrote Democratic National Committee spokesperson Mandy McClure.
According to McClure:
•13% of Kansans rely on Medicaid or CHIP for health coverage. That includes 1 in 3 Kansas children, and 2 in 5 Kansans with disabilities.
•According to the Kaiser Family Foundation analysis, 60% of non-disabled, working-age adults who rely on Medicaid are working, many in jobs that do not provide health insurance or pay low wages. In Kansas, 80% of Medicaid enrollees are in working families.
• Only about 3% of non-working adults covered by Medicaid are not disabled, ill, elderly, caring for a family member, in school, retired, or unable to find work. Most of those who don’t work cite illness, disability or family obligations as the reason.
McClure expressed concern that having a job, and gaining income could cause some sick Kansans to lose their Medicaid insurance, because they would no longer meet the state’s despairingly low income requirements, especially since Kansas has some of the strictest Medicaid income constraints for adults in the nation. Remember, Kansas was one of the state’s that failed to take advantage of the expanded Medicare program allowed under the Affordable Care Act.
In Kansas, qualifying for Medicare or Kancare is tough. Kansas parents must make no more than 38% of the federal poverty level, or $9,348 annually for a family of four. Childless adults do not qualify, even if they have no income at all.
If the state had expanded Medicaid coverage under the Affordable Care Act, individuals would still qualify for Medicaid if they made up to 138% of the Federal poverty level, or up to $33,948 for a family of four.
To date, CMS has received demonstration project proposals from 10 states that include employment and community engagement initiatives: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.
The work requirements will likely be challenged in court.