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Ohio closer to work requirements for Medicaid: What’s really going on

Ohio is a step closer to forcing some Medicaid recipients to get jobs if they receive the government assistance.

The Ohio Department of Medicaid on Monday said it had officially submitted its request to create the work requirements for those covered through the expansion of Medicaid, the state-federal health insurance program that covers residents with low incomes or disabilities.

Medicaid was expanded in the state in 2014 under the Affordable Care Act, and the expansion in fiscal year 2018 will account for about 710,000 out of the 3 million Ohioans on Medicaid.

The new work requirements, if approved by the U.S. Centers for Medicare and Medicaid Services, would require those covered by Medicaid expansion to either have a job for at least 20 hours per week, be looking for work, or attending school or job training.

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The state estimates that about 95 percent would already either meet the work requirement or be exempt. Some of the exemptions include being 50 years or older, participating in drug or alcohol treatment, pregnancy or complying with work requirements associated with other programs like SNAP, also known as food stamps.

Out of the 36,000 enrollees that will not meet the work requirements or have an exemption, the state estimates about 18,000 will ultimately lose their Medicaid eligibility.

Ohio Medicaid is requesting permission to add work requirements because the Republican-majority Ohio General Assembly put the language into the budget last summer that required the department to do so.

Ohio Senate President Larry Obhof, R-Medina, said Medicaid expansion and its costs have been a source of frustration for him and his Republican colleagues. He said the work requirements exempt the neediest while driving those with the ability to work toward self sufficiency, which follows in the consistent theme of welfare reform since the early 1990s.

“I think we should measure our success on how many people we’ve been able to give a hand up to … helping people get back on their feet and get back into the workforce instead of keeping people dependent on government,” Obhof said.

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Opponents to the work requirements have said it will put unnecessary burdens on the poor and make health outcomes worse, not to mention wasted money on red tape.

Steve Wagner, executive director of the Universal Health Care Action Network, a consumer advocacy group, said some of the state’s response to the public comment were too vague, saying more details would come and only generally describing that the state will be a good faith effort to help people meet the requirements.

“Until we see the rules and potentially even the policy guidance to (Ohio Department of Job and Family Services), we have no idea whether or not they’ve made any real accommodations to the individuals that are really going to struggle to meet the requirements,” Wagner said.

Ohio Medicaid first proposed the work requirements in February and held a public comment period, during which dozens of medical and social service lobbying groups pushed back against the proposal.

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Ohio Medicaid’s work requirement request that was sent Monday included a lengthy list of responses to the hundreds of public comments the department received.

Several organizations, including Ohio Association of Community Health Centers, during the public comment period submitted concerns over how a person will be deemed “physically or medically unfit” for work, which is one of the exemptions under state’s proposal.

In response, the state said details of the program like “physically or mentally unfit for employment” criteria will be defined in state regulations and there would be a public comment opportunity on the proposed regulations. Individuals who are unable to work due to disability, but who do not qualify for social security, may qualify for another exemption.

The proposal includes a request for matching funds from the federal government to help people who need access to transportation and other support services in order to meet the work requirements.

“Transportation support is especially critical and Ohio believes that access to reliable transportation is the primary factor in securing and maintaining employment,” Ohio Medicaid stated.

Loren Anthes, Medicaid policy fellow with Cleveland-based Center for Community Solutions, questioned the math of how many people will lose coverage, pointing to when the state implemented work requirements for SNAP benefits. While the state had estimated 134,000 recipients would be affected, nearly 400,000 Ohioans no longer receive SNAP benefits.

“With this increased complexity, and the potential of disenrollment, the overall successes of the expansion in terms of health outcomes are in question,” Anthes stated.

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