Donald Trump can’t get anything done. He was supposedly eager to promote work requirements for Medicaid. South Dakota applied to pilot just such a work requirement in our two largest counties last year. I reported in August that a year had gone by with no action from the Trump Administration on our application; Bob Mercer follows up and finds we’re still waiting:
“South Dakota’s Career Connector 1115 demonstration waiver was submitted to the Center for Medicare and Medicaid Services in August 2018. CMS has not yet approved the waiver,” Tia Kafka, communications director for the state Department of Social Services, said in a statement Tuesday.
“We have not received any communication from CMS regarding the recent federal court rulings in relationship to South Dakota’s proposal. South Dakota’s proposal seeks to pilot employment and employment training requirements in Minnehaha and Pennington counties for a targeted group of able-bodied Medicaid recipients ages 19-59,” Kafka continued [Bob Mercer, “South Dakota Still Waiting on Request to Make Some Medicaid Recipients Work or Take Classes,” KELO-TV, 2019.10.15].
Good grief! Doesn’t Trump remember coming here to campaign for our tremendous Governor, a beautiful, wonderful lady who’s doing many many great things the likes of which have never been seen before in history ever?
But let’s not shout too loudly. Even where Trump has approved such work requirements, his administration can’t be roused to oversee it properly. A Government Accountability Office report released last week finds the Center for Medicare and Medicaid Services is throwing money to states without making sure it’s being spent effectively:
The weaknesses fall into two main categories:
- No consideration of administrative costs during approval.
“GAO found that CMS does not require states to project projections of administrative costs when requiring demonstration approval,” according to the report.
“Thus, the costs of administrating demonstrations, including those with work requirements, is not transparent to the public or included in CMS’ assessments on whether a demonstration is budget neutral.”
- Current procedures may be insufficient to ensure that costs are allowable and matched at the correct rate.
“GAO found that three of the five states received CMS approval for federal funds — in one case for tens of millions of dollars — for administrative costs that did not appear allowable or at higher matching rates than appeared appropriate per CMS guidance” [Richard Craver, “Federal Medicaid Work Requirement Report Has Implications for North Carolina Bill,” Winston-Salem Journal, 2019.10.14].
The Wall Street Journal reports the Medicaid work requirements would cost hundreds of millions of dollars to implement. NPR reports that medicaid work requirements end up kicking lots of responsible Americans out of coverage because of bureaucracy, not laziness:
“The one work requirement program that’s actually gone into effect is in Arkansas,” says Nicholas Bagley, professor of law at the University of Michigan and a close follower of the ACA. “We now have good data indicating that tens of thousands of people were kicked off of Medicaid, not because they were ineligible under the work requirement program, but because they had trouble actually following through on the reporting requirements — dealing with websites, trying to figure out how to report hours effectively, and all the rest.”
If more states are able to implement work requirements, Bagley says, that could lead “to the loss of coverage for tens of thousands — or even hundreds of thousands — of people” [Selena Simmons-Duffin, “Trump Is Trying Hard to Thwart Obamacare. How’s That Going?” NPR: Shots, 2019.10.14].
Besides, in a federal appeals court hearing Friday, it sounded like the Trump Administration is losing its case for the requirements. If Trump wakes up and takes action on South Dakota’s Medicaid work requirement application, it will just waste money for a few weeks before the courts tell us to shut it down. In this case, it’s better than we just let the lying dog sleep.
Yeah, it’s really a sick sort of elitism going on with these programs. I’ve seen some of this when I was working in this field, and helping people with various disabilities or other challenges obtain employment.
Let’s face the facts. Programs like this are designed by middle class college-educated folks with the assumption that everyone is middle class and educated, which is fine if the population served is middle class and educated. That’s not the case for most of the clients in these programs. They wouldn’t be in the economic condition of needing state assistance if they were middle class and educated. So, middle-class educated folks who administer these programs wonder that the people being served aren’t really tech savvy enough to do all the steps because they don’t have easy access to computers or they don’t know the software. And when they don’t enter the data correctly, they get bumped out of the program, even if they are actually doing the work required of them.
Our program worked with these folks and entered the data for them while teaching them how to use the damn software. The problem is most of these folks don’t have computers or smart phones that actually work, so they had to come into our office anyway, once they got to the point of being able to enter data themselves.
Somewhat related idea, Cory, if you want an argument that might resonate with Kornmann on the initiative requirements lawsuit. Check out Kornmann’s corporate farming decision. If I remember correctly, it involved someone with a disability claiming that the corporate farming restrictions prevented him from farming. Consider: that unnecessary bureaucracy required by state law prevents someone with disabilities from using their constitutional rights.
… and kristi’s campaign still hasn’t reimbursed SF for her trumpublican rally.
A number of us in South Dakota submitted comments during the public comment period about this program proposal. Maybe CMS is still reading them or trying to figure out how to respond. Better yet, let the lying dog sleep, as Cory suggests.
Meanwhile, I want to report that:
Jesus healed a crippled man, no work requirement other than picking up his mat.
He healed ten lepers, nine of which did not even thank him, no work requirement other than showing the priest they were healed.
He healed some blind men, no work requirement.
He healed a bleeding woman, no work requirement.
He healed an official’s son, no work requirement.
He healed Peter’s mother-in-law, no work requirement.
He healed a paralyzed servant, no work requirement.
He healed a man’s withered hand, no work requirement.
He healed a man who could not speak, no work requirement.
I myself received health coverage and the dignity that comes with it for over 30 years with no work requirement – simply due to my good fortune to be married to someone whose job provided for it. In all that time, I never had to report my activities to anyone in order to maintain coverage. I object to taking away health coverage, and possibly the health, of anyone not so privileged.
(Disability, Donald? Hmm… I wonder if any of the provisions we are challenging uniquely burden disabled individuals in a way that the simple logistics and physical requirements of circulating might not already.)
Cathy, maybe we can hope that some career public servants are indeed reviewing that lengthy record of public comment. I suspect no Trump appointee will be reading them.
Jesus was obviously a lazy socialist, to be mocked and thrown out of any Trump rally.
Is the Noem family still worried about the national debt What a joke.
Cathy B nailed it.
BOOM!!
In the meantime, I can’t imagine any presidential administration as perfectly bumbling and incoherently incompetent as Knuckleheaded Knumbnuts and the Gang of Stooges.
While he’s ignoring Americans in need of medical help, the trump Crime Family Syndicate is set for more ripping off the USA. That’s each one of us taxpayers. We know he will jack up prices exponentially prior to this event:
“Next year’s G-7 gathering of the leaders of the world’s biggest economies will take place at President Trump’s Doral golf resort outside of Miami, acting White House chief of staff Mick Mulvaney announced on Thursday.”
NPR, is.gd/BLivC2