In a ruling last Friday, federal Judge James Boasberg blocked Kentucky’s Medicaid work requirement. Boasberg’s ruling lays out grounds on which South Dakota citizens could challenge South Dakota’s pending 1115 waiver application for a similar Medicaid work requirement.
The ruling does not declare the Kentucky plan itself unconstitutional; rather, it finds that Health and Human Services Secretary Alex Azar’s approval of the waiver was “arbitrary and capricious” in that the Secretary “failed to ‘adequately analyze’… whether the project would cause recipients to lose coverage” and “whether the project would help promote coverage,” which are the central objectives of Medicaid. Public comment submitted to Kentucky’s plan raised concerns that the provisions of Kentucky’s plan—which include much beyond the work requirement—would reduce Kentuckians’ access to health care:
Citing extensive research, including from past Medicaid demonstrations, commenters explained how each provision of Kentucky HEALTH — namely, the (1) community-engagement requirement… (2) increased premiums… (3) cost sharing for non-emergency use of emergency rooms… (4) suspension of retroactive eligibility… (5) reporting requirements… and (6) lockouts… — would likely reduce healthcare access and utilization. To top it off, numerous comments also suggested that these new administrative requirements would increase “clerical and tracking errors and delays,” which in turn would “cause inadvertent terminations” [Judge James Boasberg, Memorandum Opinion, Stewart v. Azar, Civil Action No. 18-152 (JEB), U.S. District Court for the District of Columbia, 2018.06.29, p. 37].
Kentucky was banking on saving $331 million from 95,000 residents leaving the Medicaid rolls under its 1115 waiver. According to Judge Boasberg, Secretary Azar cited some of the Kentucky plan’s exemptions to protect people from losing coverage, but he essentially waved the magic wand of the free market, saying that the “community-engagement” requirement (80 hours a month of work or “volunteering”… which again it isn’t, not when the state makes you do it) would “creat[e] incentives for individuals to obtain and maintain coverage through private-, employer-sponsored insurance.” Judge Boasberg wanted research on that point and saw none from HHS.
South Dakota’s 1115 waiver application could suffer from a similar weakness. The Program Summary [p. 3] refers to the January 11, 2018, guidance letter from CMS Director Brian Neale urging state Medicaid directors to pursue work requirements. That letter [p. 2] cites multiple studies showing correlations between work and positive health outcomes. However, those studies say working people may suffer fewer problems that require health care; it does not say that requiring Medicaid recipients to work or volunteer or take classes will promote health coverage or cause recipients to lose coverage.
South Dakota’s 1115 waiver application does raise fewer red flags than Kentucky’s. Our plan does not include the same increases in premiums, limits on retroactive eligibility, or limits on non-emergency medical transportation that Kentucky proposed and which aggravated the potential coverage losses. South Dakota also avoids claiming any budget savings citing any specific number of individuals who would lose coverage, saying instead that “it is not clear how many individuals will increase their income above the parent and other caretaker relatives’ income limit or choose to not participate in the Career Connector program” and only gently acknowledging that “Any decreases in annual enrollment would likely also result in decreases in annual expenditures.”
Vacating federal approval of Kentucky’s Medicaid work requirement does not stop Secretary Azar from reviewing and approving South Dakota’s Medicaid work requirement. However, Judge Boasberg’s ruling does make clear that the Secretary needs to offer some solid analysis that our work requirement will promote coverage and not kick people off Medicaid.
Almost all “conservative” economic and societal “plans” are entirely ideology or “faith”-based, not based on any actual research/science/financial analysis. This is why they almost always fail to achieve their so-called “goals”.
That and they are also punitive towards the least among us. That seems to be the prime mover for wingnuts- punish the poor, just like jesus would do.
Work requirements are a good idea, no matter what they are tied to, because getting up and going to work everyday is a habit which is difficult to develop and easy to break.
Many years ago when the Clinton administration started the welfare-to-work overhaul, the state job service staff reported that it was taking, on average, 3 jobs before welfare mothers finally got the hang of getting up and going to work every day. These women had to lose the first two jobs before they figured out attendance is mandatory.
Employers are loathe to hire people who have not worked recently. People who have been unemployed for a long time are unreliable. So any measure that gets people back into the labor force is good. It doesn’t matter what the job is, it’s showing up that counts.
Work requirements are a good idea, no matter what they are tied to, if your main purpose is kicking people off welfare rolls so there is more money for koch bros taxbreaks.
http://www.politifact.com/punditfact/statements/2018/jan/26/heartland-institute/do-work-requirements-lead-self-sufficiency/
Work requirements in study after study have not increased self sufficiency nor raised income because of welfare cuts offset by increased incomes. People are really no better off than before.
Earlier welfare reform packages had money for daycare and stuff to help new job seekers. Now that money is no longer provided.
The older Anne gets the more she exagerates either with wrong facts or damaging inuendo.
80% of families on Medicaid have jobs. The others are either ill, disabled, taking care of a sick family member, attending school, retired or looking for work.
http://money.cnn.com/2018/01/10/news/economy/medicaid-work-requirement/index.html
Most of the people that I know that don’t work are lazy white people.
Somalis and Latinos work hard and at places where nobody else wants to work. Meanwhile fat American white women on Section 8 housing and middle age white men with beer bellies sit on their asses smoking cigarettes whining about their lives.
Did You Know … there’s a liquor regulation in South Dakota that retail liquor sellers can’t have blacked out windows facing the street. It’s so that busy body, overly critical and judgmental ladies can walk by and see who’s in the bar drinking in the daytime. There’s a common perception among these types that bars are full of “males on welfare” that are only busy drinkin’ up the hard earned tax money from the “good town’s people”.
*mostly false ~ Ladies … the men you see in the bars during daylight hours are usually farmers. It’s a farmers joke that, “If you’re not in the bar by noon you’re not farming right.” :0)
Here’s where I agree with Anne: work is good for people, generally. I think work should be encouraged, and people assisted in gaining employment, but you have to do that in a way that makes sense. Threatening to take benefits away is the absolute wrong way to do that. Also, when it comes to people on Medicaid, many already work or are disabled or elderly. In some cases, the problem is the employer doesn’t provide adequate insurance or a wage adequate for them to purchase health insurance. If the goal is to lift people off Medicaid, it would be more effective to raise the minimum wage to $15 an hour.
I come from almost 20 years of experience in finding and developing jobs for hard-to-employ people. In all that time I found very few people who aspired to do nothing. Almost no one wants to be a bum, because people want to be a benefit to society. Some people do self-sabotage, but they can be worked with and that becomes much less of a problem.
What Anne describes regarding people having difficulty adjusting to work can be true if the process neglects what Anne describes as a problem with what we in the biz call “soft skills” and “work hardening.” Also, many hard-to-employ individuals have health and mental health issues that have to be worked around. “Unreliability” often comes from being reliable in other areas of life—needing to take a child to the doctor or properly addressing a migraine or a mental health issue. Poor folks often lead much more difficult lives, and child care and health issues are big hurdles to get over.
Programs that set strict hours requirements that are 20-40 hours are going to fail. Get people into a job that will work for them. If it’s 10 hours per week, that’s fine, then work to figure out how they can expand those hours as they gain control over their lives.
Wingnuts have a way to take care of the Medicaid problem, as well. They will just attempt to get rid of it.
Their block grant idea is stoopid as they will allow states to use block grants for everything except maybe the intended purpose. We have seen this before. Many states used block grant moneys to balance the state’s budgets so they didn’t have to charge Chuck and David an extra penny or two in taxes.
Anne, Donald and I agree that work is good for people. We don’t say otherwise, and that’s not the point of Judge Boasberg’s ruling or this post.
Voting is good for people. Exercise is good for people. Pickles are good for people. Regular sex with a monogamous partner is good for people. But the state can’t mandate any of those things as pre-requisites for Medicaid coverage, not under current law, not without demonstrating that those requirements somehow fulfill the basic objective of Medicaid to promote health coverage, not take it away.
Cory,
Exactly. When you put people to work at anything under $15 per hour full-time, without employer paid health coverage, you are guaranteeing people will have to access the Medicaid program. There is something wrong when you fail to go after businesses who refuse to provide adequate wages and benefits, and purposely limit hours of people who want to work so the business doesn’t have to put them on a health plan. Those are the people who need to be charged for every one of their employees who have to access Medicaid.
Maybe Anne should hire immigrants to teach welfare abusers like the koch bros the joys of hard work and struggle to feed a family amidst rabid right wing viciousness and hate.
They’d do it. They’d do it and do it better than most whites if you could find whites to be good examples.
Also not guaranteed: paid sick leave at any of the jobs folks will go get to keep their Medicaid.
“work or volunteer or take classes” are very good things for people. There seems to be solid agreement on that. The cruel GOP is going about making that happen in entirely the wrong way. There seems to be solid agreement on that too, except Anne, but, well, you know . . .
So. Rather than attacking the people at the bottom of the ladder, if the GOP had even a smidgen of a heart they would start at the top rung to repair the system so that petty and onerous work rules aren’t necessary. But that means they’d have to kick themselves in the ass first. They’d have to ask Putie’s permission.
Admiring people are equating Medicaid with the non worker
However do the research on Medicaid payers in nursing homes …..
Or will these recipients be exempt? I’m reading from iPhone again perhaps I missed this in CH article SD is full of nursing residents on Medicaid …….
Porter
Spot on I was looking for that same link thanks
So is it financially viable to seek out the 20% according to this article stats? Mandate more when they are actually working? Would it not be more profitable for individuals and economies
To educate or actually pay people more vs head hunting the recipients?
Just sounds like these GOP people want to enforce slavery, starting with the ones who are the least able to protect themselves. The GOP just use the “politically correct” word “volunteer.” How can you volunteer when it is required?
Biggest abusers of Medicaid, besides insurance companies, are WalMart, Micky D’s and other multi- national corps who actually assist their underpaid employees to sign up for Medicaid and SNAP programs because they are too cheap and wingnuts are too un-kristian to make korporate amerika pay a livable wage.
Here are other misconceptions wingnuts love to bandy about to stir up their base- https://www.snopes.com/fact-check/43-percent-food-stamps-illegal/