A Facebook correspondent looks at Health Secretary Kim Malsam-Rysdon’s suggestion that Governor Dennis Daugaard wants to require new Medicaid recipients to work and asks if that’s even legal.
The answer appears to be no:
Federal law clearly enumerates Medicaid eligibility criteria. Although states have flexibility in designing and administering their Medicaid programs, the Medicaid Act requires that they provide assistance to all individuals who qualify under federal law. Thus, for example, a court struck down a state’s attempt to add eligibility requirements beyond those contained in federal law, including ensuring childhood immunizations, wellness check-ups, school attendance and refraining from substance abuse. The court reasoned that since the Medicaid Act contains no such requirements, the state restrictions were inconsistent with and therefore preempted by federal law. A state “cannot add additional requirements for Medicaid eligibility,” it declared [Corey Davis, “Medicaid Expansion Work Requirements,” National Health Law Program, 2013.10.04].
Utah found out states can’t add work requirements to Medicaid earlier this year:
Utah will still not be allowed to require Medicaid recipients to work, even though the president has offered Utah Gov. Gary Herbert more flexibility on the issue, federal officials said Wednesday.
U.S. Health and Human Services Department spokesman Ben Wakana said “encouraging work is a legitimate state objective” and the agency looks forward to continuing negotiations with Herbert over Medicaid expansion.
“However, work initiatives are not the purpose of the Medicaid program and cannot be a condition of Medicaid eligibility,” Wakana said [Michelle L. Price, “Feds: Utah Will Not Get Medicaid Work Requirement,” AP via Washington Times, 2015.01.07].
Governor Daugaard is following the lead of Utah, Indiana, Arizona, and other Republican-led states that are looking for some conservative face-saving way to accept ACA’s Medicaid expansion, but the feds have never approved a waiver for a Medicaid work requirement.
Even if President Obama made his umpteenth centrist swing to compromise with Republicans (kind of like the entire RomneyCare that he passed in 2010) and said okay-fine to Governor Daugaard, work requirements are bad for public health:
Having lots of uninsured people makes it harder to control infectious diseases. Uninsured people are much less likely to go to doctors when they’re sick. And if sick people avoid doctors, their illnesses remain undetected and untreated, endangering not only themselves but also those they encounter. For example, early detection and treatment of HIV infection greatly reduces the probability that an HIV+ person will spread the infection [Bill Gardner, “Debunked: Every Republican Reason for Adding a Work Requirement for Medicaid,” New Republic, 2015.05.05].
Contrary to what these proponents of work requirements believe, Medicaid can actually help individuals find and keep a job. States can offer supportive employment services to people with mental illness, 17.8 percent of whom are unemployed. They often want to work and can do so if they receive appropriate employment supports, such as job training.
…Imposing work requirements on low-income adults is inappropriate and can be counter-productive. Such requirements can cause people who aren’t working due to a chronic condition or mental illness to remain out of Medicaid and uninsured, which means that they miss out on mental health, substance abuse, or other treatment that might help them become more employable [Jessica Schubel, “No Need for Work Requirements in Medicaid,” Center on Budget and Policy Priorities, 2015.05.01].
…and punish people who have pretty good reasons for not being in the traditional workforce:
Of the uninsured who could gain Medicaid coverage who were not working, most report major impediments in their ability to work. Nearly one in three (29%) reported that they were taking care of home or family; 20% reported they were looking for work; 18% were in school; 17% were ill or disabled; 10% were retired, and 6% had another reason [Kaiser Family Foundation, “Are Uninsured Adults Who Could Gain Medicaid Coverage Working?” KFF.org, 2015.02.01].
Legally and practically, the Medicaid expansion work requirement is a non-starter. Governor Daugaard should drop this conservative talking point and admit that the benefits of a straight-up expansion of Medicaid under the Affordable Care Act is well worth the cost.
Not legal? Sheesh! How’s a governor supposed to implement Dickensian workhouses, anyway?
Maybe Denny got some ideas from the Monty Python hospital sketch where doctors don’t deliver medical care, but instead are drill sergeants barking at patients: https://www.youtube.com/watch?v=52EEzBNn48g
Cory, You finished with “Legally and practically, the Medicaid expansion work requirement is a non-starter. Governor Daugaard should drop this conservative talking point and admit that the benefits of a straight-up expansion of Medicaid under the Affordable Care Act is well worth the cost.”
The governor might also want to drop his mandate that the Federal government take over the medicaid being used by Native Americans through the IHS. To wit the announcement on the Rosebud of the closing of their IHS emergency room, because they are underfunded and understaffed. Seems like when it comes to healthcare and education, this country and state want to kick the can down the road and let the haves profit more and those doing the work to be underpaid and overworked.
Daugaard wants everyone to think he is the smart one of the bunch of right wing radicals that are trying their damnedest to take over the rest of the country. All of these things he is trying to do, first with the Indian Health Service and now the work force have been laid out by the other fascists. It ain’t gonna work. Dummy and the his gang are not going to be able to steal from it, but the state could get an influx of honest money from the fed to help run things here and give the people honest healthcare. Dummy is gonna need that moolah with the Chinese coming after him.
It all connects, Lanny!
These points are critical in any discussion of Medicaid expansion. Thanks Cory for researching and writing this article.
Cory, I believe your analysis is correct. Federal law determines the eligibility requirements, not state law.
Repubs don’t their own understand basic psychology. Negative reinforcement (like corporal punishment)simply doesn’t work. It is, more than anything, a manifestation of underlying sadism, and people affected by it – unless they are masochists react NEGATIVELY to it.
OOps, pardon my dyslexic typing – “don’t understand their own” basic psychology. :)
Could it be that Kim, who has spent an entire career working with fed\state programs at the Dept of Human Services, the Dept of Social Services, and now the Dept of Health, would know the legalities and was just assisting the governor with posturing to look as if he was trying to aid our South Dakotans in need?
This stuff is crazy. I don’t get the posturing going on by Pierre on this one? Do Daugaard, Kim and others know something we don’t?
I’m lost. Complete chaos. Complete.
Daugaard’s “logic” is total crap. He is saying his opposition to participating is because “The feds might require the state to pay in more than 10% at some time.” In the meantime idiot Republican Daugaard has prevented South Dakotans from getting two years of expanded medicare. My guess is that he has already “wasted” enough federal money to pay the 10% for twenty years or more.
What kind of a moron turns down $millions on the supposition that at some point getting those millions might cost more than 10%? You businessmen out there, if you could invest 10% and net 90% on it would you turn down the deal? Republican Daugaard is neither a good Governor, nor a good businessman, nor a decent human being with any concern for the rest of South Dakota.
EB-5 and US Department of Education funding should be restored to South Dakota only if Health Secretary Kim Malsam-Rysdon can raise Rich Benda and the Westerhuis family from their graves.
Douglas is right on. We could have been providing health coverage, saving lives, and enjoying all sorts of federal health care stimulus for the last three years. But Daugaard found that investment too costly. Arrgghh!
You could have had the first 2 years with Obama paying 100% of the tab. What a bunch of dumbass,selfish,inconsiderate ideologues running your state.
Dennis, buddy, you aim too low. Why stop at Medicaid? Go for Medicare, too. Then you can put my 84-year old Alzheimer-wracked, half-blind, mostly deaf, oxygen-thief Mother to work. Mom could competently run one-half of your corrupt state programs with one hand tied behind her 98-pound back – using her good eye.
Dennis, I pray that one day folks will treat you as you would treat them.
As I’ve been saying since the Medicaid Expansion was first offered and rejected by South Dakota, Daugaard will press for the program.
His intentions aren’t humane mind you, they are purely economic. Daugaard is finally realizing the money that doctors and healthcare providers will make and want a piece of the economic prize.
Just as with food stamps, it comes down to who really makes the money, sure poor are able to eat with food stamps, but who puts the cash in their pockets?
DC should deny federal disaster assistance to South Dakota unless utilities work for minimum wage.
The bridge across the Missouri River between Fort Pierre and it decrepit neighbor to the east should be replaced with a surplus military pontoon structure.
All bridges across the Missouri except the one at Chamberlain should be knocked down. All bridges across the Cheyenne except the one at Wasta, too.
Like any Republican Daugaard assumes poor are lazy. Which as used said Cory is simply not true. A lot of them have multiple jobs.
Any Republican, Mr. Reitzel? Some of you fellows sure deal in all-inclusive terms much of the time. It makes you less credible.
name me a Republican that doesn’t believe that?
But I see your point Grud. Ok 99% of Republicans.
Every ignorant libbie would say that. That’s why everybody with common sense hates them.
Speaking of ignorant Grud……look in the mirror. I’ve seen more Republicans, especially the far right, say that the poor are lazy. Too deny that is ignorant.
I did not type anything about the poor being lazy.
I will type, similar to what you typed, that all libbies are lazy.
Mr. reitzel used to be more credible, but now everybody thinks him incredible.
Mr. reitzel is always on the wrong side of elections.
Mr. reitzel is a libble, so all libbies have no credibility and are on the wrong side of elections.
….or could it be this?
Bruce Yackley: Denny, we really need more welders, laborers and floor sweepers at Trail King.
Governor Tool: Jeez Bruce, we have spent lots of thousands trying to attract people from Minnesota to come work for you. It’s been hard getting people who make $25 an hour to cross the border for your $13 with a probability of layoff again.
Yackley: Listen Denny. I need welders, laborers and floor sweepers. Pronto.
Governor Tool: Well, let me get my crack team led by my son-in-law on the problem. We’ll get it fixed for you.
Son-In Law: Sure Dad. We have all these unemployed people on Medicaid. That is an untapped resource for really cheap labor. Let’s force them to work for Trail King.
Governor Tool: Get ‘r done, son. Good work. That’s genius.
Republican Governor Chris Christie of New Jersey (I’m no fan, believe me) made a decision right away to expand Medicaid in his state when it was available. His comment? “We can’t afford not to”.
Dana, I wonder if NJ having a Democratic legislative majority had anything to do with Christie’s choice (http://www.ncsl.org/Portals/1/Documents/Elections/Legis_Control_2015_Apr1_1pm.pdf)
http://www.nj.com/politics/index.ssf/2015/11/democrats_win_their_largest_nj_assembly_majority_in_36_years.html
Christie is the “Outlaw Jersey Whales.”
Quite possibly, Jake. However, the guy uses his veto pen on quite a bit of paper that gets sent to his desk. Whether it is common sense gun safety (sent to him by NJ GOP), re-working the NJ voting system, etc…
My point as it relates to Mr Daugaard and how he always touts “being a good steward of taxpayer money” and spending money wisely – At least Christie saw the economic downfall of not expanding Medicaid.
Does any one here know about the State’s interest in getting companies like Walmart and Menards in Pierre to hire people from the rez? There is no housing in Pierre and they want people to commute to and from work every day at Walmart wages. So an 8 hour day becomes an 11 hour day and you still can’t feed your 4 kids
My job involves finding employment for the 17 percent of the pie (people with disabilities) who many would think are unemployable. All have some sort of Medical Assistance, Wisconsin’s term for Medicaid. I work with the folks who have severe brain injuries, developmental disabilities or mental illnesses. Most have a basic need to be productive members of society. The vast majority of these people want to work, and the vast majority do seek jobs and hold at least part time work most of the time.
But you really have to understand something about each person to understand why they might not be working full time or all the time and you have to understand that many businesses aren’t set up to hire these folks.
In this regard I would just ask how many jobs in state government are really open to people with severe disabilities? Part of my work involves consulting with businesses about “job carving,” a different way of putting together job descriptions that group simple tasks spread over many job categories into one job. This gives a person with a severe disability a chance to meet job task requirements, and thus pick up a full time or part time job, while making your other employees more productive.
If state leaders are intent on putting people to work, why don’t they do something constructive to help make it happen. In fact, why isn’t their some accountability measure for them to make it happen. They like to take credit for x number of jobs created, but why isn’t it their responsibility to find and create more opportunities for folks on the bottom of the opportunity ladder?
Why does the state accept highway funds and not Medicaid ?
Well, Charlie: the 20 SDGOP donors who would benefit from repeal of the estate tax wouldn’t be able to screw you and the other 800,000 South Dakota residents if the state didn’t accept highway funds to get subsidized product to market.
As a legislator my no vote on medicaid expansion had little to do with a blindness or indifference to the need of money for a group of people to get healthcare. ((There was a significant turn off factor for me in the filthy rich non-profit health systems pushing for it.)) To be honest I’d rather say no to road funding if there were a choice between the two, and I was VC of the transportation committee. No secret here my view is the govt is broke and broken and SD is a dependant state and vulnerable. You’ll recall I tried to suggest ways to wean us off federal dollars and so with that serious concern, saying yes to additional funding was not something I wanted to do. Some days I weakened and thought, take it while it’s there. If you think there will be no day of reckoning and that Federal dollars grow on trees, just print more!, then there is absolutely no reason to vote no. I don’t know that I’d run again as a Republican, and certainly not as a Dem. My view has become that Republicans are selectively fiscally conservative – never a need to trim military spending, ever. Never a shortage of incentives for business friends – quite anti-free market if you ask me. And they are selectively for small government. If I had to choose between Ag subsidies and medicaid expansion, I’d pick medicaid. If I had to choose between teachers and medicaid expansion, I’d choose medicaid. It’s important. But there is no interest to cut anything else, ever, and so adding to our federal dependancy is something I didn’t support.
I’m anxious to hear the budget address this week.
Another one to be filed under Republican/Daugaard hypocrisy.
Funny that the Governor is the head of a welfare household and if you think about it, his demand for Medicaid recipients to work to contribute to their household income the same as demanding that welfare states also work to bring more money in…like taxes.
But Daugaard is a taker and leads the charge that we should live off the Federal government teat rather than contribute on our own.
Not to mention, Daugaard is the Reaganesque welfare queen driving a Cadillac and buying twinkies, beer and cigarettes if you want to compare that to what the State of South Dakota has done with the corruption and fraud that they have done with Federal grants for EB-5, DOE etc.
They want people to put some skin in the game and get off of public assistance, but in the same breath they have made no taxes (skin in the game) evil. They are morally worse than the people who now and can receive Medicaid. Basically saying, we want your money but we don’t want to work for it.
Duagaard and the SDGOP have made creating jobs that qualify for Medicaid a business model to sell to the world and then wonder why people need assistance for the basics of healthcare.
Governor daugaard employs his owns son in law as chief of staff. scott westerhuis employed his own wife (they didn’t even NEED benefits ironically). no difference between daugaard and westerhuis ethics. so it is no mystery why daugaard will continue to kill people that need medical care but can’t afford it. rounds is the same. none of their family members likely NEED benefits like Medicaid Expansion. there are qualified candidates for those jobs that are not related, not in the same party, and not in the “you scratch my back-i’ll scratch yours” often machismo “club”.
oh, and have a nice day!
Leslie you are right on!
Over at Troy Jones shared political blog the War College he is mocking the Dems for not having candidates. I really thought he was smart enough to figure out that there is no money in being a Dem.
When the state one party rule lavishes gifts, money and power to those who side with them, it’s tragically obvious. Add in the “Mean Girl” mentality of the GOP and how they have bullied and bought their way into power…it’s certainly not their governance…it’s fear not getting on the government teat and retribution that keeps the Dem #’s low.
A bigger shovel is all you need now to bury the dead people as a result of your callous vote Mr. Hickey. You speak as it you have beaten the bad rap that was being put up on you with your signature issue, what makes you think you can even hold office? Oh yeah, this is South Dakota.
Pastor Hickey, I understand the political/fiscal point, but I’m going to have to go with the “take the money while it’s there” argument. Couldn’t we analogize the argument to any revenue source, state or federal? The apocalypse or mega-sequester that you’ve envisioned would shut down much more than Medicaid. It would shut down road funding, defense spending, Social Security, you name it. But that possibility doesn’t tell me that we should stop laying asphalt or training soldiers or helping Grandma buy groceries. We should do what we can with what we have as we look for ways to make those programs sustainable. Not expanding Medicaid right now, while the government is fully able to do so, isn’t helping make the program more sustainable or prepare us for the End Times. It’s just leaving tens of thousands of our neighbors sick and without health security.