“But instead our current system takes millions of dollars from hard-working Michigan families and gives completely free benefits to people who are oftentimes perfectly able to work and earn their own health coverage.”

He added that it “puts able-bodied participants on the path to self-sufficiency…”

State Sen. Mike Shirkey, R-Clarklake, who negotiated changes to the measure with the Snyder administration, said it is “all about trying to find more workers.”

Michigan, like Arkansas, would impose a requirement that Medicaid recipients work 80 hours a month in a paid job, job training program, volunteer position, internship or undergo substance abuse treatment. Beneficiaries who don’t meet the requirements for three out of 12 months will lose coverage for at least a month and will have to meet them before they are reinstated.

As in Arkansas, recipients are to report their hours each month. The measure is to take effect in Michigan in 2020 if approved. It’s not yet clear whether or how Michigan will provide reporting options beyond online.

Fiscal analysts say the work rules could apply to about 540,000 of the 670,000 individuals insured under the expansion of Medicaid known as Healthy Michigan, which covers individuals age 19 to 64 making up to 133 percent of the federal poverty level. Medicaid recipients average roughly $16,000 annually in benefits.

The measure allows for exemptions for pregnant women, people with disabilities, full-time students, those in job training, caretakers and the “medically frail,” a number estimated at 130,000 recipients.

Still, the state House Fiscal Agency estimates that up to 54,000 recipients could lose coverage under the work rules, a calculation primarily based on estimates from other states with approved waivers. And a 2018 academic study suggests the work requirement could land hard on individuals with physical and mental health issues.

The agency also found that nearly 50 percent of adults enrolled in Healthy Michigan were working, with about 28 percent out of work. The latter group included individuals not classified as disabled but had a variety of chronic physical and mental health issues. Within this group, 74 percent had a chronic health condition and more than a third had a mental health condition.

It’s unclear how many of these would meet the state’s medical exemption standard.

In Arkansas, advocates for the work rules continue to argue they are a reasonable incentive for personal responsibility.

Arkansas Gov. Asa Hutchinson said in September the work requirement is not meant to be punitive but was designed to “balance values” and help those “who are trying to help themselves” through work.

But Bruno Showers of Arkansas Advocates for Children and Families, a nonprofit advocacy group, said it’s only served to punish low-income workers by tripping them up with bureaucratic rules and a system that’s tricky to navigate.

With more than 12,000 recipients booted thus far from Medicaid, Showers expects that number to climb, since the initial work rules rollout applies to adults age 30 to 49. It expands to Medicaid recipients aged 19 to 29 in 2019.

“I hate to say I told you so, but I told you so,” Showers said. “That’s why we were opposed to this. There’s not any evidence anywhere that work requirements pull people out of poverty.”

To the contrary, Showers said, the combination of the state’s complex mandatory online reporting requirement and poor Internet access among the poor has yielded predictable results: Ejecting qualified recipients from the rolls.

Arkansas ranks 48th among the states in broadband access. And at least one fourth of Medicaid recipients subject to Arkansas work rules do not have access to the Internet, according to the Urban Institute, a Washington D.C.-based liberal think tank.

National surveys indicate this could be a barrier for Michigan as well, as 28 percent of U.S. Medicaid adults do not use the Internet, according to the Kaiser Family Foundation, a nonprofit health care research organization.

“They tried to make this as automated as possible,” Showers said, a claim the state does not dispute.

Indeed, Arkansas Department of Human Services Director Cindy Gillespie said the online-only reporting requirement is an effort to save money.

“If you implement it in the old-fashioned way of ‘Come into our county office,’ we would have to hire so many people,” she said after the waiver was approved.

To report work records through the state web portal, enrollees must have an email address to log in and must link their account to their Medicaid case. That requires a reference number that clients may or may not have received in mailed notices. Users have reported trouble accessing the site through smartphones.

Beyond that, the web portal has been shut down each day from 9 p.m. to 7 a.m., which officials said was necessary for updates and maintenance of the site.

The most recent data coming from Arkansas is not encouraging. That state’s October records show that of the more than 15,000 recipients required to report work records more than 12,000 – or nearly 80 percent – failed to do so. Showers said that strongly suggests many remain either unaware of the requirements or unable to file reports online.

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From Arkansas, a warning to Michigan on Medicaid work rules – Bridge Michigan