Ohio has asked the federal government for permission to require that Medicaid recipients meet a work requirement. Fifteen other states have made a similar request. One, Arkansas, has moved forward with implementation. Mike DeWine has been supportive of the concept, though the governor has added that he doesn’t want the result to be “punitive in any way.” The concern is that there really is no way to avoid a punishing effect.
That is because the majority of working-age recipients already work, and those who do not generally are disabled, or care for an ailing loved one, or are raising a child, or otherwise are not in a position to sustain employment. Such is one of the insights of an astute assessment of work requirements released last week by the Georgetown Center on Poverty and Inequality in Washington, D.C. The study serves as a caution to the governor and state lawmakers: A work requirement for Medicaid, and other programs such as food assistance and housing subsidies, actually risks making things worse for many recipients.
How so? The study emphasizes that the work requirement reflects a misunderstanding of Medicaid and recipients. Medicaid is supportive. As Ohio has learned through the state’s own evaluations of the Medicaid expansion, the health coverage provided makes it easier for recipients to find work and hold a job. In addition, the program brings an element of stability, easing a source of worry or a potential financial burden.
Bear in mind, Medicaid recipients are poor, living below, at or just above the poverty level, $21,330 a year for a family of three.
A work requirement amounts to a paperwork hurdle. To keep their health care coverage, recipients must document their work or training, in an accurate and timely way. That can be challenging for many when employment and schedules are inconsistent, as often is the case for those with low incomes. Recipients may not meet the required threshold for hours even though they are doing all they can to work.
Does it follow to deny someone health care in such circumstances? As the study points out, this approach has been tried through similar restrictions on cash assistance as part of welfare reform in the 1990s. One result has been many falling into deep poverty, their lives taking a severe turn for the worse.
The study also contributes constructively in reminding about the difficult job market. That may seem out of whack in view of the low unemployment rates, 3.9 percent nationally and 4.6 percent in Ohio. Yet the national rate for African-Americans was 6.6 percent in December, a figure, the report notes, that at a state level could be high enough to trigger extended federal jobless benefits.
It once was accepted that a 4 percent jobless rate added up to full employment. At that point, is it fair to ask many of the least employable to find work or lose their Medicaid coverage?
A work requirement isn’t just an added burden for recipients, coverage more dependent on accurate documentation. It is costly for administrators, who must devote strained resources to moving the necessary paperwork. All of it leads to where the study arrives in describing work requirements in the main as “ill-informed, ineffective, inefficient and inequitable.”
A legal question still hovers, whether a work requirement clashes with the first purpose of Medicaid, to provide health coverage to those with low incomes. Yet even a requirement that survives in court lacks practical merit. Medicaid provides a measure of stability for the disadvantaged and in doing so enhances opportunity. With health coverage, recipients are in a better position to succeed. Why, then, advance the prospect of taking it away?