Some Conservative States Don’t Use Medicaid Hardship Waiver – For Political Reasons | Healthcare in the United States

Some conservative states that have rejected hardship exemptions related to new Medicaid requirements may choose not to do so for political reasons, experts say.

New federal work requirements for Medicaid, set to take effect January 1, mean that adults enrolled under the Affordable Care Act (ACA) Medicaid expansion will need to work, attend school, volunteer, or participate in another qualifying activity at least 80 hours per month to maintain coverage.

The bill also includes federal exemptions intended to help low-income people maintain their Medicaid coverage when they are hospitalized, need to travel for medical care or if they live in areas affected by disasters or high unemployment.

Most recently, New York City adopted a high unemployment exemption for the Bronx, where about 200,000 residents would otherwise have been subject to the new requirements.

However, some states like Missouri and Iowa are choosing not to have this exemption for their residents, according to new research from KFF, a health policy nonprofit, although they have counties that would qualify for this exemption.

The Guardian has contacted state departments in Missouri and Iowa for comment.

Experts told the Guardian why this might be the case – including states not wanting additional administrative burden and various political factors.

Jennifer Tolbert, deputy director of KFF’s program on Medicaid and the uninsured, highlighted the ideological opposition.

“If (state officials) are proponents of work requirements, they may think that those work requirements should apply to everyone equally and whether or not someone lives in a county with high unemployment shouldn’t really be a factor,” Tolbert said.

“It could also be an administrative burden, if the state were to adopt this hardship exception, it would have to submit the data on an ongoing basis to CMS and then make sure that its system, its eligibility system, is able to exempt or exclude people from these work requirements based on where they live and whether they reside in a particular county. So that could also be a factor.”

Sarah H Gordon, associate professor at the Boston University School of Public Health, also pointed out that politics comes into play behind these states’ decisions.

“States that do not use the hardship exemption tend to be more politically conservative states that generally align with the idea that health insurance should be tied to employment or other community engagement activities,” Gordon said. “Medicaid is a federal program and there are many variations between states. »

She added: “Not using this exemption is partly political. We have states adopting the work requirements earlier, states taking less time to make sure they understand the new requirements. It’s just a patchwork of implementation where some states go above and beyond to try to minimize coverage losses and other states really don’t and a lot more people will lose coverage.”

Joel Ferber, director of advocacy at Legal Services of Eastern Missouri, said it is “disappointing” that the state is not currently considering these exemptions that could potentially benefit its residents.

“They say it’s not the case because they don’t want to create additional bureaucratic burdens for participants, but that doesn’t make any sense.

“If you surveyed Medicaid participants and said, would you rather lose your health care or fill out a hardship form, 100 percent of them would probably choose to fill out the form. So it just doesn’t make sense,” he continued.

Most notably, the introduction of these new requirements will cause millions of Americans to lose their health coverage. A clear example of this policy in action is Arkansas, which introduced Medicaid work requirements in 2018. By the end of that year, more than 18,000 people had lost coverage, but researchers found no significant increase in employment.

Jacob Wallace, associate professor at the Yale School of Public Health and Medicaid expert, called the new work requirements “very concerning.”

“Historically, they don’t encourage people to work, but they seem to generate administrative burdens and paperwork that cause people to drop out of the program,” Wallace said. “There is great concern that loss of coverage may occur, and we hope that states will try to mitigate these losses as best they can.”

He added: “And the more hoops we ask people to jump through to exempt or qualify for the work requirements, the more people we lose just because we don’t have the right address or phone number. We send out the paperwork but it’s confusing and we don’t provide enough support for people to do the paperwork.”