Medicaid Work Requirements -Mississippi, Kentucky, Oklahoma and Arkansas Scenarios

Last month, when Kentucky was ordered by a federal judge to conduct further review of its plan to require “able-bodied” Medicaid recipients to accept work requirements, the state countered by re-opening the proposal’s public comment period to August 18 – giving citizens, organizations and other stakeholders another chance to be heard on the subject.

Mississippi is also seeking federal permission to implement Medicaid work requirements. But unlike Kentucky, Mississippi has not expanded its Medicaid eligibility. Since 2013, Kentuckians who earn up to 138% of the federal poverty level (FPL) can qualify for Medicaid. Expansion has reduced the percentage of uninsured Kentuckians from 14.3% in 2013 to 5.1% in 2016.

In Mississippi, however, Medicaid is available only to families earning 27% of the poverty level or less which, at most, is an annual income of $6000. 14.3% of Mississippians are uninsured and, with work requirements, this percentage will likely rise. According to the Georgetown University Health Policy Institute, “Under the waiver proposal, Mississippi’s poorest parents would be required to work at least 20 hours a week, which at minimum wage would equal an annual salary of $7,540. That would be nearly $2,000 too high to qualify for Medicaid in Mississippi.” This is the catch-22 that CMS refers to as the “subsidy cliff” (see 5/15/2018 WA for details on this).

The Washington Post reports that most Mississippians on Medicaid are “African American mothers living in rural areas.” At present, most of the 14% of Mississippians on Medicaid are children. The state’s Division of Medical Assistance estimates that work requirements, if approved,”would reduce the Medicaid rolls by 20,000 over the next four years,” according to US News and World Report.

Oklahoma is also pursuing work requirements without expanding Medicaid. The Georgetown University Healthcare Policy Institute reports that, if implemented, the policy “would predominantly affect Oklahoma’s poorest mothers” and would be hardest on “small towns and rural communities, where parents are more likely to receive Medicaid and where jobs are harder to find.” Oklahoma’s 13.8% uninsured rate is exceeded only by 14% uninsured in Alaska and 16.6% in Texas.

Meanwhile, advocacy groups in Arkansas – in a variation on the Kentucky strategy – are suing the Department of Health and Human Services for giving the state permission to implement work requirements. The National Health Law Program, Legal Aid of Arkansas and the Southern Poverty Law Center are alleging, according to the Washington Post, that the “administration’s approval of the state’s plan is unconstitutional, violates Congress’s power and undermines the basic purpose of the safety-net program created in the 1960s as part of President Lyndon B. Johnson’s War on Poverty”.

Kentucky and Mississippi are accepting Open Public Comment on their Work Requirement Proposals until 11 PM ET on August 18, 2018.

Directions for submitting your comments are available here: https://www.chn.org/wp-content/uploads/2018/08/intro-to-work-req-comments-KYandMS.pdf

Why Are STDs Rates Increasing When HIV Is Relatively Stable?

Bringing the three most common STDs (gonorrhea, chlamydia, syphilis) under control is one of the eight key challenges that CDC Director Robert Redfield is expected to identify in the agency’s new HIV/AIDS plan to be unveiled at the United States Conference on AIDS’s upcoming Leadership Conference. They are “prevention and testing, care and treatment, structural interventions, research, viral hepatitis, sexually transmitted infections, opioids and the overdose epidemic, data and metrics”.

Nationally, these three STDs are at an all-time high in the US. The Washington D.C. Health Department reported increases of all of these in the last year, despite the fact that hepatitis C and tuberculosis have decreased somewhat and HIV cases has remained constant in the District.

Public health officials attribute the STD increase to a variety of factors. Vox notes drastic cuts to the CDC’s STD prevention funding that supports state health departments and clinics that supply confidential testing and treatment. David Harvey, Executive Director of the National Coalition of STD Directors, told the Economist that, “clinics offering confidential services are especially important for young people, who often do not seek testing through their general practitioners both because of stigma, and because doctors do not really like to talk about sex”.

Vox also notes that many people now see sex as less risky. Access to Pre-Exposure Prophylaxis (PrEP) and longer-lasting contraceptive methods have resulted in reduced condom use. These factors, along with political pressure to suppress any public sex education other than “abstinence only” have contributed to the STD rise. Another contributing factor may be the increase in HIV testing. This, often coupled with STD testing, may simply be identifying more STD cases.

In any case, investment in keeping STD clinics and other testing sites open and accessible, along with realistic safer sex education, are essential to reduce STD spread.





View the latest HIV Policy Update here.