Ohio Poised to Try Medicaid Work Requirements Again
By Dan Skinner, Ohio Capital Journal / December 23,2024
And once again it's bad policy
Medicaid work requirements are back again. And they are just as bad an idea this time as they were before.
The stated aim of Ohio’s proposed Medicaid waiver, posted for public comment this Tuesday, is “to improve Medicaid enrollee health and well-being through incentivizing work, education, and addiction recovery.”
Deceptive rhetoric aside, the actual effects of these requirements couldn’t be more different — or worse.
Medicaid work requirements are barriers to receiving vitally important health care services. And they take aim at the already most vulnerable Ohioans. The waiver will cut coverage for tens of thousands of Ohioans, add more government red tape in basic access, and increase insurance costs for all of us.
This isn’t just my opinion. Courts have already weighed in, striking down a work requirement law implemented in Arkansas in 2018. By the time federal courses stopped the program in 2019, 18,000 adults had lost coverage.
Even more damning: work requirements did not drive more Arkansans with Medicaid to work. In fact, the program cost the government more to administer than it would have cost to simply maintain health coverage. The same is true in other states like Kentucky and Virginia where administrative costs totaled in the hundreds of millions.
Past work requirements were found to have violated the aims of the legal provision by which they are established — so-called 1115 Demonstration Waivers established under the Social Security Act. These waivers were established to drive innovation in the delivery of Medicaid, not to keep Americans from enrolling. Acknowledging this legal determination, several states, including Ohio, put their proposals on ice.
The news that Ohio is going to try again is a clear effect of the 2024 election. Ohio is hoping that likely Centers for Medicare and Medicaid Services administrator, television personality Dr. Mehmet Oz is more open to them. The DeWine administration is also hoping that courts will be more open to work requirements this time around.
The Truth About Work Requirements
Ohioans may ask: Why shouldn’t we make Ohioans work for coverage?
If the waiver were about policy, then we would maintain current access because we know it reduces Ohioans’ debt, enables them to get better jobs, and helps state economies improve in general. Ohio already has data demonstrating this fact. But the work requirements being proposed will only make Ohioans comply with another government mandate for something they already pay for through their taxes.
Ask yourself this question: Do I want more Ohio government in my health care? If the answer is no, then why would some Ohio Republicans be pushing this policy on the poorest Buckeyes?
The important thing to understand is that this is about politics, not policy. The fact of the matter is, the overwhelming majority of individuals on Medicaid already work, are in school, or are a caretaker of a relative. And while the waiver recognizes some of that, the state readily admits that more than 60,000 Ohioans will lose coverage. More than that, the state also admits the average costs for enrollees will increase, which means insurance costs increase for those in the private market.
As happened in Arkansas, the proposed waiver is not likely to push more Ohioans to work, get help, or learn. It is, however, likely to serve as a significant barrier to enrollment in Medicaid. This is what we political scientists call “administrative burden.” Every conceivable Medicaid work requirement will reduce the number of people able to access Medicaid services.
Public Comment is Open, But Ohioans Might Miss It
The DeWine administration posted public notice about these consequential enrollment barriers in a sly manner, on Dec. 16, just days before Ohioans’ focus turns to the holidays and time with family. In-person and virtual public comment will be held twice, just after the New Year, on Jan. 3 and Jan. 9. Ohioans can provide written comment, as well. The administration is availing itself of the statutorily smallest window for public comment, which closes on Jan. 16 — just four days before President-elect Trump is sworn in for a second term.
The clear goal is to push Medicaid work requirements through without too many Ohioans noticing, and to have these barriers to Medicaid enrollment teed up for Trump and Oz when the new administration takes control.
Medicaid Saves Lives
Don’t be fooled by the DeWine administration’s Orwellan evocation of “enrollee health and well-being.” Real health and well-being is promoted by increased access and the removal of administrative barriers.
The proposed requirements are part of a longer effort to undercut Medicaid and punish poor Ohioans. The administration will likely tell us we are overreacting, that these proposed requirements will bring some accountability to Ohio Medicaid. The fact that Ohio decided to slow their efforts until full MAGA control of the federal government should tell us all we need to know.
The DeWine administration posted public notice about these consequential enrollment barriers in a sly manner, on Dec. 16, just days before Ohioans’ focus turns to the holidays and time with family. In-person and virtual public comment will be held twice, just after the New Year, on Jan. 3 and Jan. 9. Ohioans can provide written comment, as well. The administration is availing itself of the statutorily smallest window for public comment, which closes on Jan. 16 — just four days before President-elect Trump is sworn in for a second term.
The clear goal is to push Medicaid work requirements through without too many Ohioans noticing, and to have these barriers to Medicaid enrollment teed up for Trump and Oz when the new administration takes control.
Medicaid Saves Lives
Don’t be fooled by the DeWine administration’s Orwellan evocation of “enrollee health and well-being.” Real health and well-being is promoted by increased access and the removal of administrative barriers.
The proposed requirements are part of a longer effort to undercut Medicaid and punish poor Ohioans. The administration will likely tell us we are overreacting, that these proposed requirements will bring some accountability to Ohio Medicaid. The fact that Ohio decided to slow their efforts until full MAGA control of the federal government should tell us all we need to know.