November 1, 2018

Medicaid Work Requirement Watch – Wisconsin

On October 31 Wisconsin became the fifth state to receive approval from the Centers for Medicare and Medicaid Services (CMS) to dictate that able-bodied state residents receiving Medicaid comply with work requirements as a condition of getting their benefits.

Wisconsin has not taken up the Medicaid expansion per the ACA. Governor Scott Walker is staunchly opposed to it and supports Medicaid work requirements. He is running against Tony Evers, a Democrat who vigorously supports Medicaid expansion and opposes mandatory work requirements. The result of next Tuesday’s election, therefore, will directly impact Medicaid beneficiaries (and their families) in Wisconsin. The Hill reports that if Evers is elected, he could “withdraw or change the waiver”. The Gubernatorial race in Wisconsin is currently very close.

If implemented, Wisconsin’s waiver will require recipients to work at least 80 hours a month. The Hill adds that “if they fail to do so for 48 aggregate months (any amount of time not working that adds up to four years), they will lose coverage for six months.” The waiver also allows the state to “charge premiums on beneficiaries, and to lock people out of coverage if they fail to pay.”

Wisconsin joins Kentucky, Indiana, Arkansas and New Hampshire in having received CMS approval for work requirements. Kentucky’s waiver, however has been blocked by a federal judge and is now pending further litigation.

ACA Enrollment Period More Constrained Than Ever

On November 1, the Affordable Care Act (ACA) system started its current open enrollment period with fewer resources than ever before. Unfortunately, this cut-back in federal investment does not signal a reduction in the number of Americans who need coverage. In fact, the opposite is true.

The Kaiser Family Foundation reports that, prior to wide-scale ACA implementation in 2013, 20.5% of non-elderly adults in the US were uninsured. By 2016, that percentage had dropped to 12.5% – an improvement attributed to the ACA. In the last two years, however, its progress has been shrinking, especially in states without Medicaid expansion. In the population overall, according to Forbes, the percentage of uninsured people rose from 12.5% in 2016 to 15.5% of the US population by May 2018. Four million new people, as of this year, are now uninsured nationwide.

Despite this, the Trump administration persists in reducing support for the ACA, starting with shortening its open enrollment period. The 2016-17 open enrollment period extended from November 1, 2016 to January 31, 2017. At the end of 2017, however, open enrollment was limited to six weeks, and the current period is from November 1 to December 15, 2018.

During the earlier enrollment periods, extensive media outreach was provided (including through digital media, e-mail and texts) to encourage uninsured people to contact their local ACA marketplace and review their options. In 2016, $100 million was allocated to fund this vigorous public outreach. According to ACJM, the government’s investment in this publicity dropped to $34 million in 2017. It is now “making $10 million available to help publicize and market the plans in the 34 states where ACA exchange plans are facilitated by the federal government.”

Finally, the budget to hire ACA Navigators has been slashed from nearly $63 million in 2016 to $36 million in 2017 and then to $10 million in 2018. According to the DHHS website, the “navigators play a vital role in helping consumers prepare applications to establish eligibility and enroll in coverage through the marketplaces.” Unfortunately, few consumers will have access to navigator services this year. The New York Times reports that, “in nearly one-third of the 2,400 counties served by, no navigators have been funded by the federal government” during this year’s enrollment process.

Meanwhile (as noted in the Weekly Advocate’s 6.29.18 issue), Short Term Limited Duration (STLD) insurance plans are now being aggressively marketed with the administration’s full approval. These plans (sometimes called “junk” insurance) are inexpensive, do not meet ACA standards and are not required to cover pre-existing medical conditions. But their low cost makes them attractive to individuals who have to meet their ACA “individual mandate” obligation and are not well informed about the deficiencies of these plans.

View the latest Policy Update here.