Arizona, along with many other states, is looking to impose work requirements and five-year lifetime limits on “able-bodied” adult enrollees in Medicaid. This is a necessary part of a comprehensive reform that will create a fiscally stable safety-net program while continuing to provide health insurance to the neediest members of our community.
Critics are quick to point out all the problems that such requirements may have, citing things like increased administrative costs, along with the human toll on those who may not be able to work, but nevertheless fail to qualify as disabled and hence cannot earn an exemption, or the negative impact on individuals who are unable to get work because they are full-time caregivers.
Studies, like that from the Kaiser Family Foundation, claim a majority of Medicaid enrollees are already working, making such requirements unnecessary. Then there are many who feel the proposed work requirements and lifetime limits could undermine access to care for felons, people suffering from untreated mental illness and some of the poorest, especially within the homeless community.
These issues are all necessary points of consideration when trying to find a comprehensive solution that will ensure that Medicaid will continue to provide health-insurance coverage for the poor and disadvantaged members of our society. However, to help ensure that it remain solvent for years to come, there must be a mechanism in place that encourages enrollees who can to find work and get out of the program as well.
Not only are reforms like work requirements essential to maintaining Medicaid’s viability, but they also serve to incentivize financial independence from government support.
Historical proof of this can be found from the welfare reforms of the 1990s that instituted work requirements for the Temporary Assistance for Needy Families cash-assistance program (TANF). Places like Portland, Oregon, and communities in California saw enduring, robust effects of people getting off and staying off of government assistance. More recently, there were the Republican-led efforts in Montana that linked its Medicaid expansion bill to job training.
The goal was to mandate everyone getting benefits meet with a labor specialist who would help them get a job or a better-paying job. However, since federal statute says states can’t currently make participation in a work program mandatory for Medicaid recipients, Montana had to make its job-training component voluntary.
Having access to these kinds of programs to help people find work has already seen positive results in Montana. This tracks similarly with those communities who saw lasting effects with their TANF program as work requirements in those communities were coupled with strong training, subsidized work and placement programs that invested significant time and resources into securing just those results.
Heidi Capriotti, spokeswoman for the Arizona Health Care Cost Containment System, or AHCCCS, told me that one of the problems facing the state Medicaid program is that there is no real way of knowing which enrollees are currently working, since reporting employment status is not necessary for acceptance. Neither is there any way to determine how long someone has been unemployed while enrolled, even if they are able-bodied.
It seems logical that there is a substantial portion of those currently enrolled who are in fact taking advantage of the current lack of a work requirement to stay ensured, though fully capable of getting work. The Kasier study referred to earlier says 51 percent of individuals studied are employed, which means 49 percent are not. That’s quite a large portion, especially if they are able-bodied!
Medicaid should remain a viable safety net for our most-vulnerable community members, while providing a bridge out of poverty, rather than turning into a poverty pit, or worse, a system that allows those with no intention of bettering themselves to take advantage of the charity afforded by taxpayers.
