Modern Healthcare reports
that leading Democrats in Congress are pushing the Trump administration to release information about the administrative costs of implementing new work requirements for the Medicaid program in red states, including Arkansas:

The Democratic ranking members of the Senate Finance and House Energy and Commerce committees, Sen. Ron Wyden of Oregon and Frank Pallone of New Jersey sent an oversight letter to the CMS Tuesday asking how many state and federal dollars are being spent to administer new Medicaid requirements such as work mandates and premium cost-sharing.

The Trump administration has given three states — Kentucky, Indiana and Arkansas — the green light to require able-bodied adult Medicaid enrollees to work or volunteer in order to get health coverage.

Alabama is getting ready to close the open comment period for its own Section 1115 Medicaid waiver that would also impose a work requirement on a much smaller population that is mostly comprised of the elderly, disabled, and working poor parents with dependent children.

In their letter, Wyden and Pallone cite the estimated $374 million Kentucky would need over two years to implement its newly approved work requirement.

They also note that the premium cost-sharing Indiana and Michigan require for their Medicaid populations have also been expensive, as analysts from the Kaiser Family Foundation have said, although the true cost is unknown.

“The public should have complete information about the consequences of proposed Section 1115 waivers to ensure limited taxpayer dollars are being used efficiently, appropriately, and towards the goal of promoting, not obstructing, access to healthcare,” Wyden and Pallone write.

To be clear, work requirements would have a cost-saving offset, it’s just an ugly one: An increase in the uninsured rate. There’s no evidence that Medicaid work requirements would increase the number of people who are working, but there is strong evidence that imposing bureaucratic hurdles to the program will lead to some people being kicked off the rolls. That would save states money, which is the real point of this exercise. Arkansas provides an example that illustrates that policymakers are more focused on slashing coverage than on promoting work opportunities for low-income people: As hundreds of thousands of Arkansans are set to receive letters about the new work requirements, the state is making zero additional investment in funding for work support services such as job training for Medicaid beneficiaries.


Wyden and Pallone’s point is that Medicaid dollars are supposed to be spent to increase coverage and access to health care, and taxpayers should have a clear account of the significant costs of administering these new bureaucratic programs. They are a laughably inefficient mechanism to try to increase workforce participation; instead, that money is being spent to bury poor beneficiaries in paperwork in a stealth attempt to cut coverage.

Most Medicaid expansion beneficiaries are already working — and many more are unable to work because of serious health problems. Others are people we wouldn’t expect to be working, such as students, homemakers, caretakers. Arkansas provides exemptions for many of these folks but the exemptions themselves require paperwork that must be continually filed. Those already working will have to report their “work activity” on a monthly basis on a website. This program will require the state to implement a massive effort to track the monthly activities of more than 100,000 of its citizens and append a new bureaucratic maze to an already complex program. This in turn demands a robust outreach effort, but the state has consistently underinvested in outreach and education for Medicaid beneficiaries — most egregiously when shockingly poor communication and a notice process that violated federal law led to tens of thousands of beneficiaries being kicked out of the program despite the fact that they were eligible according to the state’s own data. It’s not hard to guess how this story will end: Thousands of poor Arkansans — including those who are working and those who should be exempt from the requirements under the state’s rules — will fall through the cracks and lose coverage.


Good for Wyden and Pallone to insist: If Republicans want to bury Medicaid beneficiaries in paperwork and bureaucratic complexity , we ought to know the price tag.