March 28, 2019

Medicaid Work Requirements in 2019

Eight states, according to the Kaiser Family Foundation, have received approval to date from the Centers for Medicare and Medicaid Services (CMS) to implement Medicaid Work Requirements. Seven more have similar requests pending. Here is the status of those approved:

Arkansas: According to Time Magazine, over 18,000 Arkansans have lost their Medicaid coverage in the last ten months for “failing to comply with the requirements or failing to officially report their compliance.” On March 14, U.S. District Judge James Boasberg (who blocked the state of Kentucky from dropping people from Medicaid last June) “heard oral arguments in two separate cases challenging plans in Arkansas and Kentucky”. His decisions on these cases are pending.

Kentucky: Following Boasberg’s June 2018 ruling, the state re-applied to CMS and got a second approval to implement mandatory work requirements. If the state is blocked a second time, Kentucky’s Governor has pledged to end Kentucky’s Medicaid expansion altogether.

Indiana: In February 2018, Indiana became the second state to enact Medicaid work requirements, although its program was not initiated in January 2019. An estimated 70,000 to 80,000 Medicaid recipients should be participating in the program but enrollment has been slow. Participants will not actually be required to start working until July 1, 2019. They are also not at risk of losing coverage for failure to comply until 2020.

Michigan: With CMS’ approval in 2018, the state began to impose work requirements (80 hours per month) on food stamp recipients between 18 and 62. It is on track to impose similar requirements on nearly 700,000 Medicaid recipients in 2020. When submitted, their CMS proposal had the strong support of then-Governor Rick Perry (R). But Governor Gretchen Whitmer (D), elected last November, opposes it and is negotiating with the state legislature regarding its further implementation.

Wisconsin: Received CMS approval in October 2018, becoming the first state to do so without expanding Medicaid. As in Michigan, Wisconsin’s green light was obtained under a Republican Governor, Scott Walker. Tony Evers (D), their new Governor elected in November, opposed the project. Last December 5, however, the state’s legislature “locked in” the project with a close vote held right before the newly elected governor and legislature took office.    

Arizona: Approved in January 2019, they expect to start in January 2020. All participants (ages 18-49) have to report (in person, by phone or online) their accomplishment of at least 80 hours of work activities each month. Failure to do so by the tenth day of the subsequent month will result in exclusion from Medicaid coverage for two months.

New Hampshire: Their approved CMS application includes the largest work requirement (100 hours per month) proposed by any state to date. Implemented last March 1, the program gives participants an “on-ramp” period of 75 days (until June) to report the number of hours they are working. Meanwhile, data from the Arkansas experience has triggered heated public debate about the project. The state legislature is considering ways to revise their Work Requirement rules to avoid abuses, as well as bills proposing to do away with the program altogether.

Ohio: Last March 15, CMS approved Ohio’s request and the state expects to implement in 2021. Medicaid recipients between 19 and 49 will be enrolled and will lose their Medicaid if the fail to meet requirements (working 40 hours per week and reporting their week within 60 days). Those who default, however, will be able to immediately reapply for enrollment.

Tune in next week for our overview of how the new Omnibus Healthcare Bill Introduced on March 26 could affect people living with HIV and their health care providers!

View the latest Policy Update here.