New “Work Requirements” Threaten Medicaid: What You Need to Know

ACA Medicaid Expansion Insured 550,000 New Jersey Residents

The Medicaid expansion is a vital provision of the Affordable Care Act. Medicaid expansion is a lifeline connecting people experiencing homelessness to preventative care, substance abuse treatment, life-saving surgeries, and more.

Recently, the U.S. Department of Health and Human Services (HHS) indicated that it would allow states greater flexibility in how Medicaid is run.

States may now apply for waivers that would require Medicaid recipients to comply with work requirements, impose new cost-sharing obligations (e.g. co-pays or monthly premiums), and eliminate coverage requirements for certain essential health benefits.

Last week, Kentucky:

  • raised premiums,
  • removed coverage for dental and vision care, and
  • imposed work requirements on beneficiaries.

The news from Kentucky potentially foreshadows how Medicaid could be further eroded. Nine additional states have similar waivers now under consideration by HHS.

In a recent article, the Center on Budget and Policy Priorities (CBPP) writes, “HHS’ approval of Kentucky’s waiver also sends a dangerous signal to low-income people in states such as Arizona, Arkansas, Indiana, Kansas, Maine, New Hampshire, North Carolina, Utah, and Wisconsin, where similar – in some cases even harsher – proposals are pending. The HHS Secretary can let states deviate from certain Medicaid provisions, but HHS is supposed to grant such waivers only to the extent necessary to implement demonstration projects that promote Medicaid’s objectives to furnish health care services to low-income individuals. Waivers should enhance coverage and improve the delivery of care. They shouldn’t let states make changes to Medicaid that hurt beneficiaries by causing them to lose coverage or make it harder for them to get health care.”

Although New Jersey does not have a Medicaid waiver, it is important to monitor what is happening across the country.

On June 28, 2013 former New Jersey Gov. Chris Christie (R) signed a state budget that included $227 million for Medicaid expansion in the state.

Officials estimated that in 2014 about 300,000 uninsured state residents would be insured under the expansion. Christie vetoed legislation that would have made the expansion permanent in the state.

A March 2017 NJSpotlight article, “ACA Medicaid Expansion Helped NJ Save Millions in Charity Care” reported “State officials note the reduction largely reflects the ACA’s Medicaid expansion, which has added 550,000 Garden State residents to the insurance rolls in recent years. Hospital bills documenting the charity care they provided dropped 53 percent in the past two years alone, they said in a report released Thursday.”

Monarch Housing Associates urges New Jersey’s Congressional delegation to oppose any replacement of the Affordable Care Act that eliminates Medicaid expansion.

It is critical that Congress moves to raise the important role Medicaid expansion plays in ensuring people experiencing homelessness receive critical healthcare services.

Not Out of the Woods Yet: State Waivers Threaten Medicaid Expansion

Families USA Medicaid 1115 Coverage Waivers Resource Center

Families USA Guide to Tracking Work Requirements

CBPP Analysis of Kentucky Waiver

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