Work Requirement for Medicaid—Will This Idea Fly in Illinois?

It seems there are always plenty of “Breaking News” stories at the end of the week, and many have wider, more immediate, and more personal impact than Mr. Trump’s most recent tirade with expletives.

Last week, January 11-12, was no exception when the Center for Medicare and Medicaid Services issued guidelines allowing states to develop and test programs to require able-bodied adult Medicaid recipients, between ages 19 and 64, to participate in at least 80 hours of “employment activities” per month. In addition to paid employment, these activities include job training, education, and community service. Ten states so far have welcomed this policy change—Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin.

Kentucky’s waiver was submitted for approval the first time back in 2016, and in addition to the 80 hours per month of “employment activities” required of recipients, the plan also imposes a premium based on income to be paid by recipients of Medicaid. Those who miss a payment or fail to re-enroll will be locked out for six months.

Keep in mind that according to the Kaiser Family Foundation, 60% of adult Medicaid recipients across the nation have jobs. Most adult recipients who do not work reported one of these major barriers as the reason: a criminal record, homelessness, lack of education or training, an empty job market, no access to public transportation, or a disability that doesn’t meet the legal definition of disability, just to name a few.

Kentucky Governor Matt Bevin stated on NPR last Friday: “Kentucky will now lead on this issue.” And speaking of Medicaid recipients, he added, “They want the dignity associated with being able to earn and have engagement in the very things they’re receiving.” The governor spoke with such conviction I could only wonder if he spoke from his own experience. However, Rep. John Yarmuth, D-Ky, stated that he found the change “dangerous and irresponsible” and predicted it could result in tens of thousands of Kentuckians losing their health coverage.

The Tribune has reported Governor Bruce Rauner is reviewing the new guidelines, but it’s too early to tell if Illinois will follow the lead of neighboring states Wisconsin and Indiana. The Illinois Hospital Association and other patient advocate groups have made clear they hope Illinois does not join the ten states. Critics of work requirements state the fundamental purpose of Medicaid is to help low-income people access medical benefits, and they also claim work requirements are based on the false claim that poor people are lazy and don’t want to work.

These opposing arguments remind me of the age-old question, which comes first–the chicken or the egg? Does a poor person seek work because (s)he has received healthcare and is feeling stronger and more ready to engage? Or, should an unwell person be forced to work or meet similar requirements as a stipulation to access healthcare? To me the discussion boils down to a very simple question: Don’t all human beings have a right to health care, regardless of their economic station or employment?

Submitted by Bev George

Indivisible Naperville

Reporting on Health Care

January 15, 2018


NY Times (Jan. 12, 2018)

Chicago Tribune (Jan. 11, 2018)