BEYOND THE NUMBERS
New Hampshire has suspended a policy to take Medicaid coverage away from people not meeting work requirements, recognizing that it was on pace for large coverage losses — potentially almost 20,000 people in August. New Hampshire’s experience holds lessons for other states, providing further evidence that Medicaid work requirements can’t be fixed. New Hampshire should recognize that as well and continue its suspension indefinitely.
New Hampshire’s policy is one of the harshest that the Centers for Medicare & Medicaid Services (CMS) has approved, requiring adults up to age 64 to either work 100 hours each month or request an exemption. The work requirement took effect on June 1, and coverage losses were slated to begin in August, making New Hampshire the second state that would have taken Medicaid away for not meeting work requirements.
Arkansas was the first state to take coverage away from people not meeting work requirements. Some 18,000 beneficiaries lost coverage in 2018 — or nearly 1 in 4 of those subject to the policy — likely contributing to the rise in the uninsured rate for low-income Arkansans aged 30 to 49 (the group subject to work requirements). The number of people losing coverage exceeded the supposed target population, evidence suggests, which means that people otherwise eligible for Medicaid were losing coverage because they didn’t request an exemption, report sufficient work hours, or consistently report their work hours each month. Despite state claims that the policy would bolster employment, there have been no significant increases in employment, number of hours worked, or overall rates of community engagement, such as community service or job training, among those subject to the requirement, a recent study finds.
New Hampshire policymakers insisted that they would do a better job with implementation, avoiding the significant coverage losses that occurred in Arkansas. New Hampshire, however, has experienced similar problems communicating with beneficiaries about the policy. Despite its multiple outreach activities, such as mail notifications, town halls, phone calls, and text messages, the state failed to reach 20,000 out of the 50,000 people potentially subject to the requirement to inform them about the new policy.
The state acknowledged that “these considerable efforts” weren’t effective. For example, on only 500 out of the state’s 50,000 phone calls was a state official able to discuss the work requirement with the person who would be affected by it. And of the state’s 1,200 home visits to date, officials reached only 150 people who would be affected. As a result, many state residents reportedly don’t know about the work requirement, or have received confusing and often contradictory notices from the state about whether they’re subject to it or exempt. In addition, the state experienced a glitch in its online reporting system, creating problems for people reporting their work hours.
Similar problems are reportedly emerging in Michigan, where a work requirement is scheduled to take effect in January. Governor Gretchen Whitmer opposes the policy and said she wants to implement it in ways that minimize coverage losses. Nonetheless, the state is reportedly struggling to develop an outreach plan that will reach beneficiaries and make them aware of the new work and reporting requirements, much less enable them to meet them. To date, there’s no coordinated outreach plan to reach Michiganders living in rural areas, no training for community outreach staff, and no printed training materials.
Policymakers in other states that are considering work requirements continue to insist that their state’s policies will have different outcomes than Arkansas. Kristi Putnam, Kentucky’s Deputy Secretary of the Cabinet for Health and Family Services, recently touted her state’s “aggressive outreach campaign and its commitment to be flexible and proactive in its effort to improve the health of Kentuckians” as reasons why she doesn’t “expect the same results” as Arkansas. And Georgia Lieutenant Governor Geoff Duncan said, “With all the modern-day technology, I’m certain we can figure out a system that is simple to use and easy to log [work hours].”
But as we’ve explained, work requirements can’t be fixed. The complexity and paperwork burdens they create will inevitably cause working people and people with serious health needs to lose coverage. And taking health care away not only won’t help anyone work, but it also will likely make it harder for some to find jobs.
Responding to this reality, New Hampshire policymakers passed a bill to let the state suspend the work requirement under certain circumstances, including if a “substantial number of people” aren’t notified about it. Governor Chris Sununu signed the bill into law and announced that his administration is suspending the policy, preventing almost 20,000 people from potentially losing coverage in August. But his administration suspended the policy only through the end of September, even though the legislation allows a suspension until July 1, 2021.
In addition to New Hampshire, six states — Arizona, Indiana, Michigan, Ohio, Utah, and Wisconsin — have CMS approval to start implementing work requirements and take coverage away from people within the next year. Others, such as Montana and Virginia, are seeking approval. These states should follow New Hampshire’s example and hit the pause button before people lose coverage. Better yet, they should overturn such policies, and New Hampshire should continue its moratorium, since its policy will lead to large coverage losses whenever it’s implemented.