Since its origin in 1965, Medicaid has stood as America’s promise to care for our neighbors and loved ones, providing health insurance for people who have nowhere else to turn. One million Minnesotans, a significant portion of which are seniors and people with disabilities but also include low-income individuals and families, receive health care through Medicaid, called Medical Assistance in Minnesota. However, federal policymakers have reneged on that long-standing promise by fundamentally shifting the priorities of Medicaid away from providing health care to low-income people.
Last month, the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees Medicaid, announced that it will approve state requests to require some Medicaid recipients to participate in work activities in order to receive health care. This defies 53 years of precedent and fundamentally changes Medicaid, potentially cutting off health care coverage for 6.3 million people across the U.S. who cannot work or find a job. Adding new barriers to health care for low-income people is counter-productive. The majority of people on Medicaid who are able to work do so, and those who do not work face substantial barriers to finding and keeping a job.
The general parameters for this new state option are that working-age people who do not have a recognized serious disability must complete and report work activities in order to continue to receive health care through Medicaid. According to CMS, work activities can include things like volunteering, participation in job training, caregiving, or active treatment for a substance abuse disorder; however, states will be able to define the exact requirements.
Adding requirements to work is a solution to a non-existent problem. The reality is the majority of working-aged, healthy adults on Medicaid already work. In Minnesota, 73 percent of low-income families participating in Medicaid have at least one adult with a full-time job. Additionally, over 50 percent of Minnesota Medicaid participants work in labor-intensive jobs in agriculture or manufacturing, and without reliable access to health care, their capacity to complete their work and remain gainfully employed can suffer.
Even for Medicaid participants who have a job, complying with the reporting requirements will likely prove burdensome and could cause some to lose their coverage because of paperwork snafus. Many of the current state proposals require people to report their hours either bi-weekly or monthly, which creates significant barriers to health care. For example, a person who becomes sick, misses work for a week, and is unable to make up their shifts prior to their next reporting period can be sanctioned or even lose health care coverage despite having a job. Taking away their health care coverage makes it more difficult to keep working.
People on Medicaid who aren’t currently working often face barriers to stable employment, such as poor health or a lack of jobs in their area. Thirty-five percent of non-working Medicaid participants in Minnesota face health issues, such as some mental health conditions, that can interfere with their ability to find and keep a job, but would not exempt them from having to meet the proposed work requirements. Others who want to work struggle to find jobs in their communities because there are few jobs to be found. It is counter-productive to take away health care for people who are seeking to improve their health so that they can go to work, or are unable to find a job in their community.
This brings us to the fundamental problem with this approach: Medicaid itself already supports work. If people aren’t healthy, they will not be able to sustain employment. While the Minnesota Legislature has not authorized the state to implement these changes in Medicaid, some legislators have indicated they are interested in exploring this idea. Ultimately implementing new eligibility hurdles to access health care is inconsistent with the promise of Medicaid and Minnesota’s commitment to affordable health care. Minnesota must stand against counter-productive new requirements in Medicaid that hurt Minnesotans’ ability to lead healthy lives.