Medicaid work requirement advances

LANSING, Mich. (AP) — Some Michigan able-bodied Medicaid recipients may soon lose their health insurance if lawmakers approve a proposal requiring them to prove they work or are training to work for at least 29 hours a week.

The proposal passed the GOP-controlled Senate passed in a 26-11 vote on Thursday. Now headed to the House, the legislation would strip the public benefit from able-bodied adults unable to meet the work quota by Oct. 1, 2019 through any combination of the following: work, employment-related education, job or vocational training, an internship or substance abuse treatment.

“‘Is having Medicaid an important asset to you and your family?'” bill sponsor Sen. Mike Shirkey said he asked Medicaid enrollees. “Almost without a doubt the answer is yes. Then the next question is why. Why would you allow it to lapse?”

Shirkey, a Clarklake Republican, estimates the pool of affected enrollees could reach 300,000 Michigan residents. The state has 2.5 million total Medicaid recipients, almost 700,000 of whom were added by the “Healthy Michigan Plan,” which is Gov. Rick Snyder’s version of the 2010 Affordable Care Act’s Medicaid expansion to low-income adults.

Exemptions include pregnant women, people receiving unemployment or disability benefits, caretakers for children under 6 and full-time students.

Snyder, a Republican, does not support the bill as is, said his communications director, Ari Adler.

“Despite our efforts to work with Sen. Shirkey, this version of the bill is neither a reasonable nor responsible change to the state’s social safety net,” Adler said. “We should not jeopardize the success of Healthy Michigan, which has helped hundreds of thousands of Michiganders.”

Republican leadership in both chambers are warm to the idea. Senate Majority Leader Arlan Meekhof of West Olive said work requirements will make able-bodied adults “self-sufficient” and House Speaker Tom Leonard from DeWitt “supports the concept in general,” said his spokesman, Gideon D’Assandro.

After amendments to soften Shirkey’s measure were shot down, Democrats took the floor to blast the majority party for what they said was punishing the poor.

“What we’re doing is setting up a system that’s not designed to keep people healthy or put people to work,” Ann Arbor Democrat Sen. Rebekah Warren said. “It’s designed to prevent access to health care.”

Michigan’s bill follows in the footsteps of a longstanding conservative dream to wean people off Medicaid, which has ballooned into the nation’s largest health insurance program. In January, the Trump administration gave states the green light to hold Medicaid recipients to a work requirement. So far, Kentucky, Indiana and Arkansas have ushered the rule in and at least eight other statehouses have OKed work mandate bills, according to the National Academy for State Health Policy.

“This kind of legislation, now that the economy and the environment has changed, is precisely what we need to do to allow Healthy Michigan to survive,” Shirkey said. “Because if we don’t, it won’t.”

It is unclear what the fiscal consequences of a work requirement would be. Michigan’s nonpartisan Senate Fiscal Agency estimates $20 to $30 million in annual administrative costs to monitor the mandate.

However, most recipients of Michigan’s Medicaid expansion would be untouched by Shirkey’s proposal. University of Michigan researchers who studied Healthy Michigan enrollees in 2016 found 54 percent were employed or in school. Of the 28 percent out of work, three-fourths reported a chronic health condition despite not receiving federal disability benefits.

“It seems probable these work requirements will only apply to a small group of enrollees,” said Dr. Renuka Tipirneni, the study’s lead author.

Claire Maitre, a 62-year-old Medicaid recipient in Ann Arbor, said if Shirkey’s bill passes, she would rather be uninsured during her final year before retirement than abandon her caretaker duties for her grandchildren.

“These politicians are caught in an ideology that does not work for Michigan’s families,” Maitre said.

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