The Department of Health and Welfare has received at least 1,121 written comments on a proposal to add work requirements to Medicaid expansion, most of them opposing the idea.
A sampling of the first 147 written comments, which came in on Aug. 26, showed 143 against the proposed work requirements, three in favor and one expressing mixed sentiments. The last 110 DHW shared, which were received on Sept. 16, show 104 opposed to work requirements. (One was ambiguous and five were about a different waiver.) This split is similar to the public testimony on legislation asking for the waiver, which was also almost unanimously opposed to work requirements.
“Medicaid work requirements may seem like a reasonable idea, but the reality is that it is a bigger problem than the original problem,” wrote Ralph Mossman of Driggs. “The original problem is that the public would like to ensure that people are not taking advantage of the Medicaid program. But spending tax money to create a new bureaucracy to address a relatively small problem, and making the lives of the people who are legitimately on Medicaid even more difficult, is not a good solution.”
Idaho voters voted in November 2018 to expand Medicaid coverage to everyone making up to 138 percent of the poverty level. Many Republican lawmakers were against Medicaid expansion, and while they passed funding for expansion this year they also passed a bill to ask the federal government for waivers to make several changes to the program. Of them, the request for work requirements was by far the most controversial and generated the most testimony in opposition.
The proposed waiver would require Medicaid expansion beneficiaries to work, volunteer or participate in work training for at least 20 hours a week, or be enrolled in post-secondary education for at least half-time. It contains numerous exemptions, such as for people under 19, over 59, and people who are pregnant, physically or intellectually unable to work, applying for or receiving unemployment or participating in drug or alcohol treatment. In the introduction to the draft waiver, DHW points to research showing a connection between work and improved health.
“(This) waiver, by conditioning Medicaid eligibility on a person’s work and community engagement activities, provides such person a strong incentive to seek, obtain, and maintain gainful employment,” the draft says. “The added benefit of such active engagement is that, while it improves individuals’ overall health and well-being, it also puts them in a better position to be financially independent and less dependent on public health coverage programs like Medicaid. Accordingly, this waiver is expected to improve the health and well-being of Idahoans subject to the requirements.”
Many of the commenters, though, said the requirements would be difficult to comply with and lead to people who are working losing coverage, or cast them as going against the will of people who voted for Medicaid expansion. Others said it could lead to litigation, as has happened in several other states.
“(Medicaid) expansion was passed, by a large majority, of well informed voters,” wrote Mike Oar of Idaho Falls. “We passed the expansion without any requirements for a reason, to help those without coverage. As a tax preparer, for the low to medium tax payer, I can say that most of these people work two to three jobs just to make ends meet. Any added requirements (do) not benefit the program but (do) create extra work for those who do not have the skills required to navigate the process.”
“I believe that if the Idaho citizens had wanted a work requirement, we would have included that in our vote,” wrote Brooke Hurt of Pocatello. “I believe that the income guidelines are enough. A family has their reasons for why they do or do not work; yes, some people take advantage of the system but overall I think that people are struggling and are trying to do the best they can.”
DHW already held two hearings in Boise earlier this month on the work requirements proposal; 64 people testified between the two, all but three against work requirements. The department is accepting written comment through Sunday, after which the proposed waiver will be sent to the Centers for Medicare and Medicaid Services for review and possible approval. Medicaid expansion coverage will kick in on Jan. 1, whether the waiver is approved or not.
Written comments can be emailed to 1115.comments@dhw.idaho.gov, or mailed to Cindy Brock, Medicaid Program Policy Analyst, Division of Medicaid, P.O. Box 83720, Boise ID 83720-0009.