Senior Policy Analyst
The Michigan House is now considering a bill, which the Senate has passed, that would take coverage away from Medicaid beneficiaries who don’t meet rigid work requirements. As our recent report explained, such a policy would jeopardize the large gains in coverage and access to care Michigan has achieved since expanding Medicaid through the Healthy Michigan program in 2014. It also would likely have serious unintended consequences, from cutting large numbers of working Michiganders off their coverage to sharply increasing uncompensated care costs for Michigan hospitals.
Some Michigan policymakers (including the sponsor of the Senate bill) have suggested that the House will modify the bill, such as by lowering the weekly work requirement from 29 hours or modifying exemptions, in order to gain support in that chamber. Yet any bill that retains the Senate bill’s core structure — in which people lose their coverage if they don’t complete and document work activities — will have the same harmful impacts.
Specifically, the Michigan bill, or any similar proposal, would:
An additional feature of the Michigan bill — that anyone who lost coverage for failing to meet the requirements could not regain it for a full year — is not in Kentucky’s proposal and would lead to additional coverage losses in Michigan.
We’ve shown that 46 percent of low-income workers nationwide who could be affected by Medicaid work requirements would be at risk of losing coverage for one or more months under a 20-hour-per-week requirement. Even among people working 1,000 hours over the course of the year — about 80 hours per month (thus 20 hours per week) — 1 in 4 would be at risk of losing coverage for one or more months because they wouldn’t meet the 80 hours in every month.
As the American Cancer Society, the American Heart Association, the American Lung Association, and other patient groups in Michigan explained, “Even enrollees who qualify for exemptions will have to provide documentation of their illness during the application and reassessment process, creating opportunities for administrative error that could jeopardize their coverage. No criteria can circumvent this problem and the serious risk to the health of the people we represent.”
Medicaid expansion in Michigan has produced large coverage gains, a sharp drop in the amount of uncompensated care its hospitals provide, and savings to the state’s budget. A Medicaid work requirement could reverse much of this progress.
Michigan policymakers should instead note the evidence showing that expanding coverage supports work and reject any proposal that imposes a work requirement on Medicaid beneficiaries.