For the first time the federal government has allowed states to develop work requirements for people on Medicaid, the low-income government health insurance program. It’s a big change, requiring people to work in exchange for health care. Utah is one of 10 states that applied to do it. At least one bill in the legislature is sketching out what work requirements could look like.
For supporters, adding work requirements to Medicaid is as much a moral reason as an economic one. The idea goes, if you’re getting something from a government program, you should work for it. In turn, that program should help you become independent.
"I am one who believes that Medicaid should serve as a pathway out of poverty," said Republican State Senator Daniel Hemmert.
Hemmert is the sponsor of S.B. 172, a bill that outlines a work requirement rule. According to Hemmert, work would be defined broadly. Besides being employed, people on Medicaid could be enrolled in classes, they could be applying for jobs or they could do community service.
"I would say it’s more just some motivation to go do something," he said.
If the bill passes, the Health Department will recommend who should and shouldn’t have to follow this rule. Hemmert says it won’t apply to pregnant women, children or disabled people, who make up a large share of Medicaid enrollees.
Health care advocates opposing work requirements say Medicaid is a health care program, not a jobs program. They say that’s the legal definition, written into federal statute. One of those advocates is Andrew Riggle who works with the Disability Law Center.
"Because of paperwork, because of having to gather proof that you have a disability, we are concerned that these are just additional hoops that people will have to jump through," Riggle said.
Riggle fears there will be lots of gray areas where people could end up losing their health coverage because they can’t meet the requirements. For example, if someone is on Medicaid but has an undiagnosed mental health problem holding down a job could be hard. Or if people addicted to opioids lose their jobs, and as a result their health coverage, then they’ll be even worse off.
Riggle continued, "those experiencing homelessness or just returning from the criminal justice system who may not have all of the required documentation at their fingertips."
Hemmert thinks his bill includes enough flexibility to take care of the gray areas that worry Riggle.
"I would hope that whatever we do there’s a place for that person to still find Medicaid coverage," Hemmert said.
At the Department of Workforce Services, Elizabeth Carver supervises the current work requirement program for SNAP, also known as food stamps. Work requirements under Medicaid would be similar to those for SNAP, and Carver’s department would be in charge of them.
"We want to be able to help those that can go back to work, and that have a desire to go back to work, but maybe aren’t sure how to get there. And we have great tools for that. But we also want to allow for flexibility for those that can’t that we’re not adding an additional burden or a barrier in their life," Carver said.
Senator Hemmert said he doesn’t want to create strict black and white lines about who has to work and who doesn’t. That leaves a lot of discretion to the Health Department. For example, should it apply to a mom with three kids?
"Do you apply it to her?" Hemmert said. "Maybe. I’m not saying yes or no. But I am asking the Department of Health to ask that question. Anyone that expects you can plan for every contingency under the sun doesn’t live on planet earth today."
One way or another, this program would create paperwork. Even people on Medicaid who already have a job would have to document their status.
Andrew Riggle said if the legislature supports Hemmert’s bill, the Disability Law Center will likely challenge it in court.