A proposal in Harrisburg would make work requirements part of Pennsylvania’s Medicaid program, as well as impose a lifetime limit of five years for Medicaid eligibility.
“We have a finite amount of taxpayer dollars. We need to make sure they go to the most needy individuals,” said Rep. Seth Grove, R-York, the sponsor of House Bill 1407.
While it’s unlikely the proposal would become law under Pennsylvania’s current Democratic governor, the idea is one that has been gaining more attention due to Republican control in Washington, D.C., and calls by some Republicans to cut Medicaid spending or completely restructure the program.
Medicaid, the health insurance program for the poor and disabled, is jointly paid for by state and federal dollars. Almost $1 out of every $4 in the commonwealth’s annual budget goes toward Medicaid, and Medicaid spending is second only to expenditures related to primary and secondary education.
The program is a major cost driver in the state’s budget; however, much of the cost is due to long-term care for elderly and disabled individuals. Mr. Grove said his proposal would only apply to able-bodied adults.
Advocacy groups like the Pennsylvania Health Access Network say they would oppose any bill that could keep people from getting needed care.
“We are opposed to any legislation that creates more burdens on folks being able to access health care,” said Antoinette Kraus, the group’s director.
Mr. Grove noted that employment is already a condition of several other public benefit programs, such as child care assistance. Following a welfare overhaul in 1996, that program also added a five-year lifetime limit and work requirements. In most parts of Pennsylvania, able-bodied adults without dependents can only receive food stamps for three months if they are not working or volunteering at least 20 hours per week.
More than 2.8 million Pennsylvanians are enrolled in Medicaid, according to the most recent publicly available state data, although many of those individuals are children, elderly or disabled.
Gov. Tom Wolf, who has expanded Medicaid as was permitted under the Affordable Care Act to include about 700,000 additional Pennsylvanians, does not support the bill. Mr. Wolf has frequently credited the Obamacare expansion with helping people achieve access to needed care, particularly for those with an opioid addiction.
A statement from Mr. Wolf’s office said the bill would “reverse progress we’ve made on improving overall health outcomes and drive people further into poverty. Policies that arbitrarily limit the amount of time an individual can receive Medicaid move away from the core mission of the program, which is to improve outcomes and the overall experience of care, improve population health, and reduce health care costs through improvement.”
Of the Medicaid expansion population, 43 percent were working either full time or part time, according to a report released earlier this year by the state’s Department of Human Services. That same report showed that in the first year of the expansion, about 45 percent used it to receive at least one preventive service, about 5 percent had a diagnosis of Type 2 diabetes, and about 11 percent had a substance abuse disorder.
No other states have a work requirement for Medicaid. The federal government has never allowed a state to condition Medicaid eligibility on work, said MaryBeth Musumeci, associate director at the Kaiser Family Foundation’s program on Medicaid and the Uninsured.
“The rationale was that Medicaid is a health program,” as opposed to a work program, Ms. Musumeci said.
Under the Trump administration, it’s possible that such requests by states could be approved in the future, Ms. Musumeci said.
Then-Pennsylvania Gov. Tom Corbett had put forth a work requirement in 2013 as part of his proposal to modify the state’s Medicaid program but ultimately dropped the proposal as it was clear the federal government would not approve it. He had then proposed a voluntary state-funded work referral program, although that never came to fruition as Mr. Corbett was defeated in his re-election bid in 2014.
“Everyone is going to agree that work is a positive thing for society and that everyone who can work should work,” Ms. Musumeci said, but it’s important to think about how such a proposal would work in practice and the administrative costs it could bring.
No other states have time limits on Medicaid.
“A time limit is inconsistent with the purposes of the Medicaid program because a time limit would be contrary to having access to continuous health insurance, and people who have breaks in coverage are more likely to forgo needed care and preventive care while uninsured, potentially creating the need for more costly future care,” Ms. Musumeci said.
A companion bill also proposed by Mr. Grove, House Bill 1354, would establish the Office of Independent Medicaid Director, making that position someone who is nominated by the governor and subject to confirmation by the Senate.
Kate Giammarise: kgiammarise@post-gazette.com or 412-263-3909 or on Twitter @KateGiammarise.
First Published: June 5, 2017, 4:41 a.m.
