MTPR

Study: Work Requirements Could Push A Third Off Medicaid Expansion

Feb 13, 2019

A new study says that the work requirements and other changes that Republicans are calling for in Montana’s Medicaid expansion program would result in a quarter to nearly half of participants losing their health care coverage.

Right now, about 95,000 Montana adults get coverage through expanded Medicaid. That three-year-old program will expire at the end of June unless state lawmakers vote to re-authorize it.

Republicans say they’re willing to do that, but only with some significant changes.

A couple of weeks ago, the sponsor of the GOP re-authorization bill, Great Falls Representative Ed Buttrey said enrollment in expanded Medicaid has to require, “community involvement,” meaning working at least half time, or doing other tasks like volunteering, or getting drug rehab.

"The community engagement certainly will result in the program enrollment decreasing, but I don’t think by much," Buttrey said.

Today, a study commissioned by the non-partisan Montana Healthcare Foundation says the opposite. 

"We could see tens of thousands of people lose health insurance coverage," says Leighton Ku, director of the Center for Health Policy Research at George Washington University in Washington, DC. He analyzed Buttrey’s draft bill and says it would substantially reduce enrollment in expanded Medicaid.

"In total around 31,000 of 43,000 Montanans would lose insurance coverage," Ku says, "A pretty big chunk. Somewhere on the order of a third to maybe 45 percent might lose health insurance coverage. Most of that is due to the work requirements."

The work requirements in a draft of Buttrey’s bill say most recipients of expanded Medicaid benefits would have to work at least half time at least nine months a year. They’re similar to requirements enacted by Arkansas in June, and for SNAP benefits, or food stamps, that date back to the 1990s.

Both Arkansas and SNAP exempt some people from the work requirements, like people who are disabled or too sick to work. And so does Buttrey’s bill, but, Ku says, "Buttrey, was putting out fairly strict requirements.

"You could be exempted if you are the full time caretaker of a child under seven," under Buttrey's draft bill, Ku said, "whereas in SNAP and in Arkansas basically any parent is exempted.

"As far as other policies have gone, they basically exempted pregnant women," Ku says, "what Representative Buttery was saying was, in order to be exempted as a pregnant women you had to have a statement signed by a doctor that said this would pose a risk to your pregnancy."

Ku’s analysis is based on a February 5 draft of Buttrey’s bill, as of this morning Buttrey had not yet formally introduced legislation.

Medicaid work requirements can also require substantial bureaucracy to track and verify, critics say. Alaska, for example, estimates the work requirements it's considering would cost $14 million a year to administer. Representative Buttrey says Montana could do it cheaper.

"We think it can be done with existing staff," Buttrey said. "We’re trying to put community engagement requirements in place for items that we already measure as a state, and we expect the state to be able implement practices which they should already have where they can share that data. So the idea is not to have a whole bunch of new folks added."

But Ku says getting state agencies to harvest the kind of very specific information that Buttrey’s bill calls for to determine whether people are meeting work requirements is harder than it may sound.

"How they get information about who's a full time caregiver of a child under seven, who is a full time student in a school that meets the qualification standards, I don't know." Ku says. "I'm not particularly aware of that that being done, and I will say in other work that I've done we've tried to do things where you combine various databases to keep track of things. And that's a big job. I mean in order to set up a system that might combine information from several different sources we're talking millions if not tens of millions of dollars in expenses to set up the systems. And it may be a year or two before you set up shop and they work right."

Ku’s analysis was funded in part by the Montana Health Care Foundation, which is non-partisan and legally not allowed to lobby, but it’s been a big supporter of Medicaid expansion because the non-profit foundation’s mandate is to improve health care for all Montanans, and it says growing the number of people with health care coverage does that. Once Representative Buttrey’s bill has been introduced, legislative fiscal analysts will come up with their own estimate of how much it will cost to implement.