Evoking Santa Claus while allowing states to take assistance away from poor people certainly doesn’t embody the Christmas spirit. Yet, the administrator of the Centers for Medicare and Medicaid Services gleefully compared Christmas to efforts that would make it harder for low-income Americans to access health care.
“The CMS sleigh has made deliveries to Kansas, Rhode Island, Michigan, & Maine this week to drop off signed #Medicaid waivers. Christmas came early for these Governors & we are proud to support local innovation all across this great country!” CMS Administrator Seema Verma posted on Twitter on Dec. 21.
Verma is talking about work requirements, a favorite tool of Republicans that are supposed to somehow magically make poor people less poor and more healthy, and more responsible. It’s faulty logic that’s already been employed in Maine, with Gov. Paul LePage instituting work requirements for food stamps that have led to more than 10,000 low-income adults losing those benefits here in one of America’s most food-insecure states.
CMS last week approved Maine’s application to impose work requirements and monthly premiums on Medicaid recipients, something LePage has been seeking for years.
On the campaign trail, incoming Gov. Janet Mills said she was opposed to such requirements. Maine does not have to implement the waiver and it shouldn’t.
A look at states that previously received waivers to impose work requirements for Medicaid — and the LePage administration’s own waiver application — prove that they are no gift to poor, working Americans. In fact, work requirements amount to a Grinch-like move to take health care away from them.
Kentucky was the first state to receive a waiver from CMS to impose work and community engagement requirements on Medicaid recipients. The Trump administration approved Kentucky’s application because, it said, employment can improve people’s health. Turns out, ensuring access to health care is what really improves people’s health.
One of Medicaid’s key objectives is “ making medical assistance available” to the targeted populations, yet Kentucky officials projected 95,000 people would lose their Medicaid coverage as a result of the work requirements. For this reason, a judge invalidated Kentucky’s work requirements earlier this year, noting the contradiction of depriving people of health care through a program that is supposed to make that care more financially accessible.
The U.S. Department of Health and Human Services has since approved a second work requirement proposal from Kentucky, which takes effect April 1.
Maine’s waiver application projects that, by 2022, nearly 4,600 people would lose coverage due to the work requirement policy who might otherwise have retained it. In addition, “providing medical assistance” is nowhere among the primary goals the LePage administration has outlined for imposing work requirements.
Arkansas was the first state to impose work requirements, on June 1. Since then, nearly 17,000 of that state’s residents have been unenrolled from its Medicaid program. Most were dropped for failing to report required work-related activity. This may not mean that they didn’t work but that they did not set up the online accounts required to enable them to report or experienced difficulty accessing or navigating the online portal. Poor households are more likely to lack internet access or appropriate devices to connect to the internet to submit documentation.
In November, the Medicaid and CHIP Payment and Access Commission, a nonpartisan legislative agency that makes recommendations to Congress and the Department of Health and Human Services, expressed high concern about the amount of people being disenrolled in Arkansas and urged that process to be suspended pending further study and effort to increase awareness.
“The low level of reporting is a strong warning signal that the current process may not be structured in a way that provides individuals an opportunity to succeed, with high stakes for beneficiaries who fail,” the commission said in a letter to HHS Secretary Alex Azar.
It is also important to know that most recipients of federal help paying for health care already work. Nearly 80 percent of Medicaid recipients live in a household with at least one worker and 60 percent of non-disabled, working-age Medicaid recipients are working. They often work for small firms that do not offer affordable insurance or work several part-time jobs.
Kicking more people off the state’s Medicaid program, also referred to as MaineCare, doesn’t magically give them a job. But it does add to their struggle to obtain needed medical care.
That is not something Santa — or any policymaker truly seeking to improve access to health care — would be proud of.