Should Medicaid come with work requirements? Ohio says yes

But an estimated 36,000 residents — 5 percent of the 700,000 Ohioans on Medicaid through the Affordable Care Act — would risk losing their health insurance if they don’t either have a job for at least 20 hours per week, look for work, or attend school or job training.

The Ohio Department of Medicaid will hold public hearings beginning in Cincinnati starting Wednesday. Public comment can also be submitted online until March 18.

The requests to add work requirements have sparked debate over whether the conditions are necessary to push people toward jobs and out of poverty, or whether the new rules will put unnecessary burdens on the poor and make health outcomes worse.

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President Donald Trump’s administration recently opened the door to let states add job requirements as part of Medicaid eligibility, which was something states have previously not been allowed to do. Ohio joins a dozen states that want to add job requirements as a condition of eligibility and Kentucky and Indiana have already been approved.

The Republican-majority Ohio General Assembly put the language into the budget last summer that required the Ohio Department of Medicaid to seek permission to add the job requirements for those covered through Medicaid expansion.

“We’re talking about healthy Ohioans of working age,” said John Fortney, spokesman for the Ohio Senate Majority Caucus. “It’s reasonable to think that if you’re able to work, then you should be working. This gets people into the workforce, giving them the opportunity to build a career in the long term, ending the cycle of dependency on government.”

Two state representatives, Nickie Antonio, D-Lakewood, and Emilia Strong Sykes, D-Akron, issued a statement condemning the proposed restrictions as further attempts to undercut Medicaid benefits expanded under the Affordable Care Act. The two argued the proposal won’t cut poverty and instead could leave residents with poorly paid and temporary jobs.

“Taking away healthcare from people in need of temporary assistance will actually keep people sicker and unable to find work. This will increase healthcare costs across the board,” Antonio stated. “Further, this will be detrimental to Ohioans who want to work and need healthcare.”

The Ohio Department of Medicaid in its proposal cited a study pointing to how Medicaid coverage helped beneficiaries hold jobs or find jobs, but at the same time the employment rate has only increased by 2 percent for those covered through Medicaid expansion.

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“These findings emphasize that more can be done to promote and encourage work and community engagement efforts that help improve health outcomes and further promote the goals of the Medicaid program,” the state wrote.

The Ohio Department of Medicaid in its application to add the requirements compared to the state’s work requirements for SNAP benefits, also known as food stamps. The department estimated it would save about $30 million the first year the requirements are in place.

Some of the exemptions include being 50 years or older, “physically or mentally unfit for employment,” pregnant, caring for children or a disabled household member, in school at least half-time, participating in drug or alcohol treatment.

Loren Anthes, who researches Medicaid policy at The Center for Community Solutions in Cleveland, said the state’s estimate of 1 in 20 residents losing their Medicaid eligibility because of the new conditions might be a conservative prediction.

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Looking to when work requirements were introduced for SNAP, Anthes said nearly 400,000 people lost eligibility compared to the initial 134,900 that the state estimated would lose their benefits. Even accounting for an improving economy, Anthes said the work requirements appear to have disqualified more people than the state predicted.

He also said that the additional administration work that it would take to monitor these new requirements will cost money that could otherwise have been spent on health benefits.

“This waiver elects to pay for red tape over health care services,” Anthes said.

By the numbers: Medicaid

700,000: Ohioans covered by Medicaid under ACA expansion

36,000: Estimated Ohioans affected by proposed work rules

$30 million: Savings Ohio predicts for first year of work rules