Since I started writing this article, the developments surrounding Medicaid work requirements have changed half a dozen times. It’s enough to give a person whiplash. It’s also (perhaps unfortunately) an illustrative example of turbulence in real-time.
A couple of weeks ago, I wrote about the number of states with Medicaid work requirements, those states with proposed work requirements, and the large amount of speculation related to these requirements in Managing The New Medicaid Work Requirements. Now in a matter of weeks, we have yet more news to report. On the one hand, the Centers for Medicare & Medicaid Services (CMS) is pushing states to implement work requirements. On the other hand, there are an increasing number of challenges to those work requirements.
What is happening at CMS?
On March 14, CMS published a blog post from Seema Verma which doubles down on the importance of allowing states to implement local innovations—specifically calling out work requirements. As part of the blog, CMS also released new guidance on monitoring and evaluating these new programs (see Good Ideas Must Be Evaluated and 1115 Demonstration State Monitoring & Evaluation Resources).
On Friday March 15, CMS approved Ohio’s request to implement work requirements. The rules, which won’t go into effect until 2021, will require able-bodied adults (with some exceptions) to work at least 80 hours a month to maintain Medicaid coverage. Ohio is the ninth state to receive approval for work requirements (one state Maine received approval from CMS, but later withdrew their waiver, see Trump officials approve Ohio Medicaid work requirements).
Finally, although less certain, the President’s budget includes language to implement work requirements nationwide for able-bodied adults (see The Latest: Budget plan seeks work requirement for Medicaid).
On the other side of the equation:
Just this week, a federal judge struck down the implementation of work requirements in Kentucky and ordered a halt to the enforcement of work requirements in Arkansas. The ruling was based on the idea that states and CMS have not sufficiently demonstrated how work requirements meet the core goal of Medicaid—providing health care coverage. Despite the ruling, many health care experts believe the fight is far from over and will likely result in the case going to the Supreme Court (see Federal Judge Again Blocks Work Requirements).
In New Hampshire, the state senate voted a bill forward that could “potentially eliminate, the work requirement for Medicaid expansion recipients” (see Senate Advances Bill That Could Eliminate Medicaid Work Requirement In NH). At the same time, a lawsuit has been introduced challenging the work requirements (see New Hampshire’s Medicaid work requirement challenged in court).
Finally, two new reports have been released countering the claims of work requirements. A Commonwealth Fund report (see How Will Medicaid Work Requirements Affect Hospitals’ Finances?) found that Medicaid work requirements could weaken hospitals’ financial positions in states that implement those requirements. Another report from the Center of Budget and Policy Priorities (see New Arkansas Data Contradict Claims That Most Who Lost Medicaid Found Jobs) found that claims that most individuals, who lost Medicaid coverage due to compliance with work requirements, did not find jobs.
What is clear from this debate is that consumers and provider organizations get stuck in an uncertain state. Without a clear path forward in either direction, executive teams don’t know where to dedicate resources or whether to invest in consumer education and engagement initiatives. Executive teams need to hedge their bets and at least have conversations on how they will address these requirements if they come to fruition. A great place to start is with scenario-based planning process, which allows organizations to envision multiple futures (see Building & Executing Strategy In A Complex Market-A Three-Phase Best Practice Model For Success).
For more on the non-traditional Medicaid expansion landscape, check out State-By-State Analysis Of Medicaid Expansion, Work Requirements & Premiums: An OPEN MINDS Reference Guide. And be sure to join us at The 2019 OPEN MINDS Strategy and Innovation Institute in New Orleans on June 4 for the session, “Taking Action On Social Determinants: New Social Support Models For Consumers With Complex Conditions”-featuring Angela Choberka, Community Partnership Specialist, Intermountain Healthcare, Amber Rich, Community Partnership Specialist, Intermountain Healthcare, and Tracy Luoma, Executive Director, Optum Salt Lake County, Optum Consumer Solutions Group.