BOISE — A bill is expected to be introduced Monday into the Idaho Legislature to put a work requirement on Medicaid expansion beneficiaries.
The bill, which is being sponsored by Rep. John Vander Woude, R-Nampa, contains a work requirement similar to the one that exists in the food stamp program, requiring Medicaid expansion beneficiaries to work, volunteer or enroll in pre-employment training. People with children under 18 would be exempted.
The bill would also end Medicaid expansion if the federal share of the cost covered dips below 90 percent. It would request a waiver to let people making between 100 and 138 percent of the poverty level get private insurance through the Your Health Idaho state exchange rather than Medicaid. It contains a request for a waiver to let the state use Medicaid funds to pay for some residential treatment services for the mentally ill and drug addicted. And it would require the Senate and House Health and Welfare committees to review Medicaid expansion in 2023 and make a recommendation as to whether to continue it.
According to the fiscal impact statement accompanying the bill, one-time startup costs to implement these provisions will be $148,650 for the state and $688,650 for the federal government, with ongoing costs of $1,486,200 for the state and $278,000 for the federal government.
The bill is scheduled to be introduced Monday morning in the House Health and Welfare Committee.
Rep. Bryan Zollinger, R-Idaho Falls, who had been working on his own work requirements bill but says he will now support Vander Woude’s instead, said there are “a lot of misperceptions” about how the requirements would work. He said people could volunteer or get job training instead of working for 20 hours a week, and people who are disabled or sick wouldn’t be forced to work.
“I’m in favor of it because I think it helps people move off of Medicaid and improve their situation to be able to afford health care themselves,” Zollinger said.
Zollinger said getting vocational training could help get a better job. And the volunteering option, he said, would help people in rural counties where job training programs might not be easily available.
“I think it’s good policy,” Zollinger said. “You’re helping the community that’s helping you.”
These measures would, if they pass the Legislature, require waivers from the federal Centers for Medicare and Medicaid Services. Waivers to use Medicaid funds to pay for mental health treatment have already been approved in 11 states. CMS has also been willing to approve waivers for work requirements. As of January eight states had approved Medicaid work requirements and eight more had waiver applications pending, according to the National Academy for State Health Policy, although only Arkansas has implemented them. The request to let people get insurance on the exchange, which would shift more of the cost of their coverage to the federal government, could be less likely to go through; CMS hasn’t approved any similar state plans yet.
Ever since voters passed Medicaid expansion via a November ballot measure Republican lawmakers, many of whom opposed expansion, have been talking about putting limits on benefits or eligibility, saying it would protect taxpayers and ensure costs don’t get out of hand. Democrats and Medicaid expansion advocates have been urging lawmakers to approve expansion without any additional limits.
“I wish that the legislators would do their homework and look at states that have tried these things in the past,” said Emily Strizich, co-founder of Reclaim Idaho, the group that pushed to pass last year’s initiative. “You cover fewer people with more money. For a guy who touts himself as being fiscally responsible, this is a pretty fiscally irresponsible plan.”
House Assistant Minority Leader Ilana Rubel, D-Boise, said she isn’t against the mental health waiver and doesn’t have a problem with insuring some people through the exchange, although she said applying for that waiver could be a waste of time since CMS is unlikely to approve it. However, she has “very serious concerns” about work requirements. By kicking some people off Medicaid, she said it would “recreate the very problem Medicaid expansion was intended to solve.”
“And I don’t see it’ll accomplish anything,” Rubel said. “Living in poverty ... is unpleasant enough that it carries its own disincentives. ... Usually there’s a reason people can’t get out of poverty. Piling these punitive measures on them isn’t going to help.”
Strizich said the measures could create a “second gap population,” and the state wouldn’t save as much on indigent health care costs as it might otherwise. And, she said, voters approved Medicaid expansion without additional limits.
“It’s frustrating to see (Vander Woude) continue to alienate the will of the people,” she said.
Both supporters and opponents of limiting Medicaid expansion have conducted polls that claim to show popular support for their positions. A poll done in late February by GS Strategy Group found 74 percent support for implementing Medicaid expansion as approved by voters and 70 percent opposition to kicking people off Medicaid for being unable to meet additional requirements. Sixty-eight percent of respondents said they would favor a job training or education program for Medicaid recipients instead of work requirements if it cost $400,000 a year, while 54 percent said they would oppose new rules if they cost $2 million a year.
However, a poll paid for by the Opportunity Solutions Project, a conservative group that is pushing for similar requirements in West Virginia, in late February found 73 percent support for Medicaid work requirements, 57 percent support for limiting able-bodied adults to 24 consecutive months on Medicaid and 59 percent support for capping the number of enrollees.
If the bill to limit expansion brings with it costs such as to administer the work requirements, the Joint Finance-Appropriations Committee would also have to take it up, said Rep. Wendy Horman, R-Idaho Falls, the committee’s vice chairwoman.
Horman said she would need to see the bill before offering an opinion on work requirements. However, she said she supports ending expansion if the federal government stops covering 90 percent of the cost. Expansion is projected to cost the state $40 million in the first full year, with the federal government picking up the other $360 million.
“It would cause deep cuts to other agencies (and) other sectors” if the state had to pay for more, Horman said.
Rubel opposes this. She views it as singling out Medicaid expansion when plenty of items in the state budget receive federal funding and aren’t automatically eliminated if the cost share changes.
“It’s very frustrating that what was worked for so hard by the voters is being singled out for such assault,” Rubel said.