We've talked a lot recently about possible cuts to Medicaid. One possible way de facto cuts could be implemented is work requirements. Mary-Beth Malcarney joins us to talk all about how such requirements would impact people who currently use Medicaid, family caregivers, and in fact, everyone in the US, including those using private insurance. Caregivers will understand that sometimes, while we may qualify for a formal program, doing the administrative legwork to receive it might be difficult to impossible. How does one prove they are a family caregiver if that is an exception, anyway?
Read the full Families USA fact sheet on Medicaid work reporting requirements here:
https://familiesusa.org/resources/medicaid-work-reporting-requirements-bureaucratic-burdens-that-threaten-working-families-providers-and-local-economies/
The Families USA health action resource page is here, with lots of information about how to make your own Medicaid story known to your legislators: https://familiesusa.org/healthactionresources/
Mary-Beth Malcarney is the Senior Advisor on Medicaid Policy at Families USA. She previously lead a project to advise the Social Security Administration on updating disability policies as they relate to the health of transgender and gender diverse people. She also worked as an assistant research professor at at The George Washington University (GWU).
Become a supporter of this podcast: https://www.spreaker.com/podcast/love-doesn-t-pay-the-bills--5692861/support.
Read the full Families USA fact sheet on Medicaid work reporting requirements here:
https://familiesusa.org/resources/medicaid-work-reporting-requirements-bureaucratic-burdens-that-threaten-working-families-providers-and-local-economies/
The Families USA health action resource page is here, with lots of information about how to make your own Medicaid story known to your legislators: https://familiesusa.org/healthactionresources/
Mary-Beth Malcarney is the Senior Advisor on Medicaid Policy at Families USA. She previously lead a project to advise the Social Security Administration on updating disability policies as they relate to the health of transgender and gender diverse people. She also worked as an assistant research professor at at The George Washington University (GWU).
Become a supporter of this podcast: https://www.spreaker.com/podcast/love-doesn-t-pay-the-bills--5692861/support.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
[Music]
(00:11):
Welcome to Love Doesn't Pay the Bills. I'm Lisa Chutey. I'm a family caregiver.
My guest today is Mary Beth Ball-Carmy. Mary Beth is with Families USA. She is the Senior Advisor on Medicaid Policy.
And we are here to talk about work requirements. Welcome, Mary Beth. Hi, Lisa. Thank you so much for having me today.
(00:37):
Yeah, I appreciate it so much. I know you can inform us and let us understand what's happening or might be happening on the federal level with Medicaid.
I always love to start with personal experiences or connection to caregiving. So, do you mind saying a little bit about your own?
Oh, sure. Yeah, so in preparing for having this discussion with you today, it really prompted me to think back in my own life for five or six years.
(01:06):
My grandmother lived with my family and my mother took time off of work to be a caregiver while my grandmother needed a lot of support. She had Alzheimer's.
And for a long while, you know, was physically doing well and could live with us at home and in the community didn't need an institutional care or sort of nursing care.
(01:29):
But she needed a lot of support and my mother being an only child without a lot of other family around was really was the support.
So she moved in with us and I think back to my mother's experience as taking a pause in her work to be a caregiver for those number of years.
And when you think about having to prove your work or your caregiving to as a condition of receiving Medicaid or health insurance that a lot of people need, that's what we're here today to talk about is the new idea that you might have.
(02:06):
To prove something about your work experience or meet an exception like caregiving, which is often an exception in the way these programs come about.
And so just thinking about my mother's experience of how do you prove your caregiver? How do you navigate when you're no longer a caregiver going back to work, all of those things.
And then having to document that on perhaps a monthly basis to the state so you can retain your Medicaid that your otherwise eligible for.
(02:36):
So yeah, that's the caregiving experience that I would offer. So it's not something personal, though. I remember being a kid in the home and helping and supporting somebody that really, really needed a lot of support.
And so many of us do, you know, so many of us have been in that situation in the earner pass or will be in the future and you can really envision how difficult it is to kind of prove yourself as as needing Medicaid on top of that.
(03:04):
Right. What percentage of people on Medicaid are already working attending school caregivers ill or disabled themselves in one of those quality.
In other words, what percentage fall into one of those categories that are generally accepted as rightfully.
(03:26):
Yeah, maybe backing up to just define the work reporting requirements, right? So it's in a number of states.
States have been putting together proposals wanting to get these in place to have the federal government approve of these work reporting requirement proposals in their states, but right it says that people have to work usually 20 hours per week or meet an exception, right?
(03:54):
There are a number of exceptions that states will allow for caregiving being one of them, but it could be disability or being in school or treatment for substance use or mental health.
There could be a range of exceptions, but it's looking broadly across these policies, what they've been.
And it's thought to be about 92% of people would meet those exceptions. So it's most people are able to meet the work requirement exceptions or definitions.
(04:26):
It's just that the paperwork to actually prove that you're working and or prove that you're a caregiver or prove that you're having disability to try to meet one of the exceptions to the policy can be really, really onerous for people.
Although most people, you know, would fall under the categories of work or exceptions, really these policies serve to just kick a lot of people off of the program because they can't meet the paperwork burden that's put in front of them.
(04:54):
And so we find that these these policies really, really result in massive coverage losses and I know you had a previous podcast where you talked about cuts to Medicaid.
So important to be talking about those and you can think of the Medicaid work reporting requirements really as a cut to Medicaid too.
It's just putting up a lot of red tape and burdensome paperwork requirements that really causes a lot of people to fall off the program.
(05:21):
Not because they're not eligible or they don't meet the requirements. It's just that they can't meet the reporting burden.
Some people might look at that and say, you know, if you qualify and you have one of those exception categories that you fit, why would it be such a burden?
Why would it all altogether prevent you from being on the program?
(05:43):
I think it's important to remember that we're talking about people who have a disability themselves, people who are caregivers and we have discussed on this program, the high administrative burden that people who are caregivers, family caregivers already have.
And the high time burden in general, like for some people that are taking care of someone with very high cutie needs, there's hardly a time to breathe already.
(06:10):
Why would it not be okay to say, hey, if people meet these requirements, then let them show that they meet the requirements.
Right. So the thing is that the way that these are set up, usually it's a monthly reporting to the state.
So, you know, what you're saying, you know, the burden of caregivers is one thing, but also thinking about, you know, somebody's access to broadband internet, right, where they live.
(06:38):
Or language proficiency, if English isn't their first language, or like you said, somebody who has a disability or experiencing homelessness, like lots of populations may have it just a challenge to report their hours, even if, you know, they meet all the requirements.
But even those, you know, situations aside, just for the average person, the way that this has happened in states that have tried it, we saw an Arkansas that just the administrative hurdles were so high and challenging that even though it was thought that about 95% of everybody would have met the requirements.
(07:17):
Only about 10% of people were really able to start reporting their work. It just was an administrative system that was that was so challenging and for all of us that, you know, that's a huge deal.
So I have only 10% actually use the program.
Yeah, out of everyone that you expect is.
Really fell off in Arkansas when this program was in place about 18,000 people just lost coverage suddenly because they just couldn't meet this, this reporting burden, the paperwork required.
(07:49):
And when you think about it for certain groups, I mean, let's think about caregivers.
It may be difficult to prove that you are a caregiver in some circumstances. You don't have a piece of paper from the state that says you're a caregiver, right?
And some states the way that they draw an exception is very narrow.
(08:10):
So recently Arizona has been designing a work requirement program.
And their definition of a caregiver is only for those who are caregiving.
Let me see who are enrolled in Arizona's long term care system. And so that's for individuals who need nursing facility level care but are staying at home, you know.
(08:32):
So that's a narrow group. And when I think about my mother caring for her mother, my grandmother, she didn't need nursing level care.
And she had a stroke and really did, but she just needed a lot of support from our families. She was for her own personal kind of safety and health.
She needed caregiving support, but she didn't need institutional care, you know, so the way that the definitions around these exception groups can be so narrow that it doesn't recognize everybody in all types of caregivers.
(09:06):
Sure. And where if the definition for disability is so narrow that it's only those that receive social security benefits, let's say that's not everybody that has a disability, right?
So the bands can be pretty narrow. And then you're stuck without being able to prove your caregiver, but not being able to work still because of your circumstance.
Right. Sometimes caregiving is temporary. It could be just right six months or something. So do you go through that whole process of registering with multiple agencies to qualify for Medicaid? Maybe maybe not. Maybe it's not feasible.
(09:41):
And then you have a time period without insurance. So, yeah, that makes some sense. And also it's pretty clear that social security applications often take a long time.
So somebody could have become disabled and yet not on social security for months or sometimes even years. So that would leave them with a large gap.
(10:05):
We're going to take a break now. Please stay right here and we'll be right back.
Thank you for sticking around. We continue our conversation. You mentioned 10% where similar programs have been implemented of eligible people actually were able to continue using Medicaid.
(10:29):
Is that about the percentage that you think might happen if the currently discussed changes go through?
So it's hard to say so for the listener that might not know the history of all of this that you know states were have been interested in designing these work reporting requirements for their states for a number of years.
(10:50):
And in the previous Trump administration states were given the green light to test out some of these programs. They couldn't they can't a state can't automatically do this. They have to have permission from federal level Medicaid to do it.
We can walk back again and remind listeners that Medicaid is a partnership between the states and the federal government. So it would be different rules in different states.
(11:14):
It would be implemented differently.
Yeah.
I'm wondering about where as a whole nationally the numbers might fall of people being cut off or not if we have an idea.
Yeah. Yeah. So up to now it's just been certain states that have wanted to implement these programs. Now at the federal level there's some discussion of having this across the board for every state as a as a requirement.
(11:43):
And the estimates as if that went through an estimated 36 million people are almost half of adults that are enrolled in Medicaid would be pushed out of the program.
As a result of if we set this as a national standard and that's just given these are just estimates estimates based on you know how these how these programs are likely to be implemented and designed and of course as you mentioned it's everything was Medicaid as a federal state partnerships so they'll be designed in different ways in different states but.
(12:17):
It would change from it would change from states needing permission to implement a work requirement especially to states being required to do so yeah and every state would have to have some form of a work requirement.
And that might still vary by state then is that right.
(12:39):
Well you would think because every state Medicaid program is so different so I you would imagine that at the federal level it would say every state has to condition Medicaid based on work reporting but different states may do that differently administratively or have different exemptions or different requirements within your state is states still have so much flexibility in how they administer Medicaid so it probably will be very in all you know 50 states and the NDC.
(13:08):
But the estimation you know if if we just told every state you had to implement a work reporting requirement it would just kick a lot of people.
You're saying maybe you're on half in the short term yeah yeah so it's a lot and then individual states that have done this to a degree have their own story about how many people were kicked out of the program or estimated to be drops from the program.
(13:34):
So it's hard to know how it will you know pan out in any given state but I should say that there's this discussion at the federal level to do this but states given now in the Biden years the Biden Medicaid leadership was not approving of these work requirements for state programs so by and large that it sort of ceased during the during the Biden years in the Trump administration knowing that that was a lot of the
(14:02):
leadership that was encouraging of these types of policies states are already moving forward to implement their own so a number of states had the wheels in motion to to put these in place regardless of what happens at the in the sort of federal level discussion going on.
And so it's every every week we're hearing of more states that either are pulling together their application to send to the to Medicaid federal Medicaid now we call the centers for Medicare and Medicaid services or they're you know a state legislature that is passing a bill to require their state Medicaid department to apply for permission from from the centers for Medicaid.
(14:49):
So states are really moving towards this and it's all kind of based on this false assumption that people on Medicaid don't work and are hanging out and don't have any reason to be on Medicaid and if we if they only worked then they would be getting high paying jobs and off the program because they'd have their own insurance.
(15:10):
Yeah, which is just not the case is so yeah and the thing is that you what the what you've seen in in states that have tried to do this is that really the the state putting in a work reporting requirement couldn't change anything about the labor market in that state right people that live in communities where the jobs available are jobs that have private insurance attached to them or you know if they're
(15:39):
working kind of the gig economy or retail or you know restaurant industry those types of jobs were ours fluctuate and you might kind of
more requirements sometimes you might not meet it others but it's not any choice of your own you people are in different labor markets are can be really challenging and these programs do nothing to address those wider constraints you know people already are motivated to work.
(16:05):
They have to pay the bills they they they so it's been shown these programs don't do anything to create conditions where employment is more likely or create you know more more people working or more jobs.
In the short term or in the long term so in fact one point that I've heard made and correct me if if you know this to be wrong but Medicaid is one of the funders of vocational rehabilitation services right for people with disabilities to be able to work so yeah without that
(16:41):
vocational rehab service then people cannot work so it's it's really nonsensical on so many levels like you have this use it we said 92% of people already either work or would fall into one of those likely exception categories
I mean they can prove it appropriately right so you already have people using Medicaid being in those categories already so it's not something that is just people who have insurance offered through their employer and just just want to go through Medicaid that doesn't it doesn't work that way.
(17:29):
Not at all not at all but you're right to pick up on something here which is that Medicaid coverage right is is in and of itself supporting work for many people right there's a lot of research and data over over many many years saying you know having Medicaid and having you know if you have a chronic condition or needs you know having those addressed and met and and medications and all those things that somebody may need.
(17:58):
Make sure healthy and able to work right and so just Medicaid in and of itself is providing those services that give people what the you know the health that they need to stay working working and productive or being caregivers whatever that they need to be doing in their daily lives that Medicaid is helping support that so you know a lot of these programs are
(18:21):
just screwing that issue that important sort of core of what Medicaid really does and how it in in and of itself is a job enhancer and and it supports supports employment and work.
Does do work reporting requirements actually improve employment in any way shape or form is there any way that it does drive people back to employment given these factors that were just talking about of that.
(18:49):
So again I what I mentioned before is this had been tried in a few states and right now George is the only state that has an active program in place but there's been a lot of interest in these you know if we're going to have these types of programs we want to know how well they do how much do they cost to the improve employment.
Do they cause people to fall off Medicaid coverage to people leave Medicaid and then go in to the private insurance or purchase their own health plan somewhere else you know how what happens so there's been a lot of of research into this and there's no evidence there's multiple reports that say this does not improve employment.
(19:30):
And in fact you know and for all those reasons I mentioned that people the thing is people are already working if they're able to and are already motivated to work very hard because they have bills to pay they have a reason to be working people are motivated to work and this doesn't change those incentives to work it doesn't change the challenges that you may experience if you live in a in a community where there aren't higher paying jobs or or there's transportation issues child care issues.
(19:59):
You know so many things that that certain communities may need improvement on these programs don't don't improve the environment around you to to make work easier it's just penalizing people for not reporting their work hours you know things that they're already doing and you know.
(20:22):
So I am going to include a link in the show notes to a lot of really well researched information that families USA put together that you have the fact sheet that has a lot of further resources from there to learn more is there anything else that you want to make sure we say before we wrap up.
(20:50):
Well I think one thing to really think about here is that you know how much these policies impact the whole healthcare system you know when people fall off Medicaid coverage because they're not able to prove that they're working or or that they meet a caregiver exception or some other exception when they lose.
So they're health coverage because of that you know that that means instability for the whole healthcare system that we all rely on right the hospitals now have to see more patients that don't have insurance to pay the bills right and so there's a lot of.
(21:27):
So research around the importance of Medicaid coverage and keeping hospitals open keeping clinics open you know just it's the backbone of the healthcare system and when we make choices either cutting federal Medicaid dollars or putting in work reporting requirements and we're really making choices that are jeopardizing the health of the healthcare system and jeopardizing hospitals that make clothes and return to rewards that clothes or clinics that clothes.
(21:54):
So whether you're on Medicaid or not you rely on those you know you rely on the healthcare system being robust and working right and so we have to remember how important Medicaid is is a backbone for all of that and so I think the work reporting requirements place a particular burden on on individual people to report their work hours but but really you know anybody you should be thinking about this as a cut to the program just like any other cut to the program that really jeopardize.
(22:23):
The health of the healthcare system around us as a whole so people who are might be thinking hey I have private insurance this doesn't impact me all be fine really should be concerned too because there may not be.
A hospital for them to go to with their private insurance is that right there might be close when you travel to other areas of the country that have lower Medicaid enrollment rural areas where hospitals have already closed you know you.
(22:52):
Even if you live somewhere where there's hospitals that are open you want to travel you want to see our beautiful country you want to go to you want the healthcare system in our country to be serving all of us and so Medicaid is so critically important for that so.
You know we shouldn't forget that so people really really should be paying attention to all types of Medicaid cuts including this particular one that puts a lot of burden on on individual people who are eligible for Medicaid and need Medicaid to keep them keep them healthy and keep them working and they're and their caregivers to when you think about how important it is for caregivers to have the health care that they need to keep them healthy and doing what they need to do.
(23:35):
Yes and that's what we all want we all want to to provide care as much as our loved one needs it and.
We might not be able to do that if we don't have healthcare ourselves or healthcare for our loved ones when it comes to outside services beyond ourselves so.
Thank you very much for for discussing this this issue I will.
(24:01):
Would you also like to mention where people could connect with you.
You know I would say one thing is that especially in the work requirement discussion having stories from caregivers who say you know this is going to impact me and here's how those those stories really matter I think it's hard to connect your personal story to.
I'm larger healthcare financing debate in Congress but here thinking about how are you going to report your caregiving hours how are you going to meet this exception how are you going to survive without Medicaid you know those questions those individual stories are so so helpful so that's one way that I would encourage people to connect with families USA as one place that is happy to collect those stories so that we can.
(24:44):
And you know show lawmakers the impact that their that their policies have and use kind of personal stories and voices those really make a difference but those stories matter at the state level as I said states are making these decisions it's not just Congress so I'm not forgetting the kind of power of voices and and stories to say you know this impacts lots of people but it impacts me as a caregiver for my children for my loved ones for my elderly parents those stories really matter so.
(25:13):
You know something I can send you Lisa in the show notes is you know our story bank and some of our advocacy toolkit materials of people are filling client to.
Right letters to Congress or call in and talk about how important these issues are.
Excellent so that would be a wonderful way for people to connect on this issue and with our group that's really trying to fight along with so many others in in keeping Medicaid whole and and there for those that need it.
(25:40):
Yeah I think there's a lot of folks who would love to see those examples of how to write to a legislator.
Yeah and whole tool for that that kind of information is is is so valuable thank you this is love doesn't pay the bills I'm Lisa Chuty if you appreciate the podcast please tell a friend.
(26:02):
[Music]
[Music]
(00:11):
Welcome to Love Doesn't Pay the Bills. I'm Lisa Chutey. I'm a family caregiver.
My guest today is Mary Beth Ball-Carmy. Mary Beth is with Families USA. She is the Senior Advisor on Medicaid Policy.
And we are here to talk about work requirements. Welcome, Mary Beth. Hi, Lisa. Thank you so much for having me today.
(00:37):
Yeah, I appreciate it so much. I know you can inform us and let us understand what's happening or might be happening on the federal level with Medicaid.
I always love to start with personal experiences or connection to caregiving. So, do you mind saying a little bit about your own?
Oh, sure. Yeah, so in preparing for having this discussion with you today, it really prompted me to think back in my own life for five or six years.
(01:06):
My grandmother lived with my family and my mother took time off of work to be a caregiver while my grandmother needed a lot of support. She had Alzheimer's.
And for a long while, you know, was physically doing well and could live with us at home and in the community didn't need an institutional care or sort of nursing care.
(01:29):
But she needed a lot of support and my mother being an only child without a lot of other family around was really was the support.
So she moved in with us and I think back to my mother's experience as taking a pause in her work to be a caregiver for those number of years.
And when you think about having to prove your work or your caregiving to as a condition of receiving Medicaid or health insurance that a lot of people need, that's what we're here today to talk about is the new idea that you might have.
(02:06):
To prove something about your work experience or meet an exception like caregiving, which is often an exception in the way these programs come about.
And so just thinking about my mother's experience of how do you prove your caregiver? How do you navigate when you're no longer a caregiver going back to work, all of those things.
And then having to document that on perhaps a monthly basis to the state so you can retain your Medicaid that your otherwise eligible for.
(02:36):
So yeah, that's the caregiving experience that I would offer. So it's not something personal, though. I remember being a kid in the home and helping and supporting somebody that really, really needed a lot of support.
And so many of us do, you know, so many of us have been in that situation in the earner pass or will be in the future and you can really envision how difficult it is to kind of prove yourself as as needing Medicaid on top of that.
(03:04):
Right. What percentage of people on Medicaid are already working attending school caregivers ill or disabled themselves in one of those quality.
In other words, what percentage fall into one of those categories that are generally accepted as rightfully.
(03:26):
Yeah, maybe backing up to just define the work reporting requirements, right? So it's in a number of states.
States have been putting together proposals wanting to get these in place to have the federal government approve of these work reporting requirement proposals in their states, but right it says that people have to work usually 20 hours per week or meet an exception, right?
(03:54):
There are a number of exceptions that states will allow for caregiving being one of them, but it could be disability or being in school or treatment for substance use or mental health.
There could be a range of exceptions, but it's looking broadly across these policies, what they've been.
And it's thought to be about 92% of people would meet those exceptions. So it's most people are able to meet the work requirement exceptions or definitions.
(04:26):
It's just that the paperwork to actually prove that you're working and or prove that you're a caregiver or prove that you're having disability to try to meet one of the exceptions to the policy can be really, really onerous for people.
Although most people, you know, would fall under the categories of work or exceptions, really these policies serve to just kick a lot of people off of the program because they can't meet the paperwork burden that's put in front of them.
(04:54):
And so we find that these these policies really, really result in massive coverage losses and I know you had a previous podcast where you talked about cuts to Medicaid.
So important to be talking about those and you can think of the Medicaid work reporting requirements really as a cut to Medicaid too.
It's just putting up a lot of red tape and burdensome paperwork requirements that really causes a lot of people to fall off the program.
(05:21):
Not because they're not eligible or they don't meet the requirements. It's just that they can't meet the reporting burden.
Some people might look at that and say, you know, if you qualify and you have one of those exception categories that you fit, why would it be such a burden?
Why would it all altogether prevent you from being on the program?
(05:43):
I think it's important to remember that we're talking about people who have a disability themselves, people who are caregivers and we have discussed on this program, the high administrative burden that people who are caregivers, family caregivers already have.
And the high time burden in general, like for some people that are taking care of someone with very high cutie needs, there's hardly a time to breathe already.
(06:10):
Why would it not be okay to say, hey, if people meet these requirements, then let them show that they meet the requirements.
Right. So the thing is that the way that these are set up, usually it's a monthly reporting to the state.
So, you know, what you're saying, you know, the burden of caregivers is one thing, but also thinking about, you know, somebody's access to broadband internet, right, where they live.
(06:38):
Or language proficiency, if English isn't their first language, or like you said, somebody who has a disability or experiencing homelessness, like lots of populations may have it just a challenge to report their hours, even if, you know, they meet all the requirements.
But even those, you know, situations aside, just for the average person, the way that this has happened in states that have tried it, we saw an Arkansas that just the administrative hurdles were so high and challenging that even though it was thought that about 95% of everybody would have met the requirements.
(07:17):
Only about 10% of people were really able to start reporting their work. It just was an administrative system that was that was so challenging and for all of us that, you know, that's a huge deal.
So I have only 10% actually use the program.
Yeah, out of everyone that you expect is.
Really fell off in Arkansas when this program was in place about 18,000 people just lost coverage suddenly because they just couldn't meet this, this reporting burden, the paperwork required.
(07:49):
And when you think about it for certain groups, I mean, let's think about caregivers.
It may be difficult to prove that you are a caregiver in some circumstances. You don't have a piece of paper from the state that says you're a caregiver, right?
And some states the way that they draw an exception is very narrow.
(08:10):
So recently Arizona has been designing a work requirement program.
And their definition of a caregiver is only for those who are caregiving.
Let me see who are enrolled in Arizona's long term care system. And so that's for individuals who need nursing facility level care but are staying at home, you know.
(08:32):
So that's a narrow group. And when I think about my mother caring for her mother, my grandmother, she didn't need nursing level care.
And she had a stroke and really did, but she just needed a lot of support from our families. She was for her own personal kind of safety and health.
She needed caregiving support, but she didn't need institutional care, you know, so the way that the definitions around these exception groups can be so narrow that it doesn't recognize everybody in all types of caregivers.
(09:06):
Sure. And where if the definition for disability is so narrow that it's only those that receive social security benefits, let's say that's not everybody that has a disability, right?
So the bands can be pretty narrow. And then you're stuck without being able to prove your caregiver, but not being able to work still because of your circumstance.
Right. Sometimes caregiving is temporary. It could be just right six months or something. So do you go through that whole process of registering with multiple agencies to qualify for Medicaid? Maybe maybe not. Maybe it's not feasible.
(09:41):
And then you have a time period without insurance. So, yeah, that makes some sense. And also it's pretty clear that social security applications often take a long time.
So somebody could have become disabled and yet not on social security for months or sometimes even years. So that would leave them with a large gap.
(10:05):
We're going to take a break now. Please stay right here and we'll be right back.
Thank you for sticking around. We continue our conversation. You mentioned 10% where similar programs have been implemented of eligible people actually were able to continue using Medicaid.
(10:29):
Is that about the percentage that you think might happen if the currently discussed changes go through?
So it's hard to say so for the listener that might not know the history of all of this that you know states were have been interested in designing these work reporting requirements for their states for a number of years.
(10:50):
And in the previous Trump administration states were given the green light to test out some of these programs. They couldn't they can't a state can't automatically do this. They have to have permission from federal level Medicaid to do it.
We can walk back again and remind listeners that Medicaid is a partnership between the states and the federal government. So it would be different rules in different states.
(11:14):
It would be implemented differently.
Yeah.
I'm wondering about where as a whole nationally the numbers might fall of people being cut off or not if we have an idea.
Yeah. Yeah. So up to now it's just been certain states that have wanted to implement these programs. Now at the federal level there's some discussion of having this across the board for every state as a as a requirement.
(11:43):
And the estimates as if that went through an estimated 36 million people are almost half of adults that are enrolled in Medicaid would be pushed out of the program.
As a result of if we set this as a national standard and that's just given these are just estimates estimates based on you know how these how these programs are likely to be implemented and designed and of course as you mentioned it's everything was Medicaid as a federal state partnerships so they'll be designed in different ways in different states but.
(12:17):
It would change from it would change from states needing permission to implement a work requirement especially to states being required to do so yeah and every state would have to have some form of a work requirement.
And that might still vary by state then is that right.
(12:39):
Well you would think because every state Medicaid program is so different so I you would imagine that at the federal level it would say every state has to condition Medicaid based on work reporting but different states may do that differently administratively or have different exemptions or different requirements within your state is states still have so much flexibility in how they administer Medicaid so it probably will be very in all you know 50 states and the NDC.
(13:08):
But the estimation you know if if we just told every state you had to implement a work reporting requirement it would just kick a lot of people.
You're saying maybe you're on half in the short term yeah yeah so it's a lot and then individual states that have done this to a degree have their own story about how many people were kicked out of the program or estimated to be drops from the program.
(13:34):
So it's hard to know how it will you know pan out in any given state but I should say that there's this discussion at the federal level to do this but states given now in the Biden years the Biden Medicaid leadership was not approving of these work requirements for state programs so by and large that it sort of ceased during the during the Biden years in the Trump administration knowing that that was a lot of the
(14:02):
leadership that was encouraging of these types of policies states are already moving forward to implement their own so a number of states had the wheels in motion to to put these in place regardless of what happens at the in the sort of federal level discussion going on.
And so it's every every week we're hearing of more states that either are pulling together their application to send to the to Medicaid federal Medicaid now we call the centers for Medicare and Medicaid services or they're you know a state legislature that is passing a bill to require their state Medicaid department to apply for permission from from the centers for Medicaid.
(14:49):
So states are really moving towards this and it's all kind of based on this false assumption that people on Medicaid don't work and are hanging out and don't have any reason to be on Medicaid and if we if they only worked then they would be getting high paying jobs and off the program because they'd have their own insurance.
(15:10):
Yeah, which is just not the case is so yeah and the thing is that you what the what you've seen in in states that have tried to do this is that really the the state putting in a work reporting requirement couldn't change anything about the labor market in that state right people that live in communities where the jobs available are jobs that have private insurance attached to them or you know if they're
(15:39):
working kind of the gig economy or retail or you know restaurant industry those types of jobs were ours fluctuate and you might kind of
more requirements sometimes you might not meet it others but it's not any choice of your own you people are in different labor markets are can be really challenging and these programs do nothing to address those wider constraints you know people already are motivated to work.
(16:05):
They have to pay the bills they they they so it's been shown these programs don't do anything to create conditions where employment is more likely or create you know more more people working or more jobs.
In the short term or in the long term so in fact one point that I've heard made and correct me if if you know this to be wrong but Medicaid is one of the funders of vocational rehabilitation services right for people with disabilities to be able to work so yeah without that
(16:41):
vocational rehab service then people cannot work so it's it's really nonsensical on so many levels like you have this use it we said 92% of people already either work or would fall into one of those likely exception categories
I mean they can prove it appropriately right so you already have people using Medicaid being in those categories already so it's not something that is just people who have insurance offered through their employer and just just want to go through Medicaid that doesn't it doesn't work that way.
(17:29):
Not at all not at all but you're right to pick up on something here which is that Medicaid coverage right is is in and of itself supporting work for many people right there's a lot of research and data over over many many years saying you know having Medicaid and having you know if you have a chronic condition or needs you know having those addressed and met and and medications and all those things that somebody may need.
(17:58):
Make sure healthy and able to work right and so just Medicaid in and of itself is providing those services that give people what the you know the health that they need to stay working working and productive or being caregivers whatever that they need to be doing in their daily lives that Medicaid is helping support that so you know a lot of these programs are
(18:21):
just screwing that issue that important sort of core of what Medicaid really does and how it in in and of itself is a job enhancer and and it supports supports employment and work.
Does do work reporting requirements actually improve employment in any way shape or form is there any way that it does drive people back to employment given these factors that were just talking about of that.
(18:49):
So again I what I mentioned before is this had been tried in a few states and right now George is the only state that has an active program in place but there's been a lot of interest in these you know if we're going to have these types of programs we want to know how well they do how much do they cost to the improve employment.
Do they cause people to fall off Medicaid coverage to people leave Medicaid and then go in to the private insurance or purchase their own health plan somewhere else you know how what happens so there's been a lot of of research into this and there's no evidence there's multiple reports that say this does not improve employment.
(19:30):
And in fact you know and for all those reasons I mentioned that people the thing is people are already working if they're able to and are already motivated to work very hard because they have bills to pay they have a reason to be working people are motivated to work and this doesn't change those incentives to work it doesn't change the challenges that you may experience if you live in a in a community where there aren't higher paying jobs or or there's transportation issues child care issues.
(19:59):
You know so many things that that certain communities may need improvement on these programs don't don't improve the environment around you to to make work easier it's just penalizing people for not reporting their work hours you know things that they're already doing and you know.
(20:22):
So I am going to include a link in the show notes to a lot of really well researched information that families USA put together that you have the fact sheet that has a lot of further resources from there to learn more is there anything else that you want to make sure we say before we wrap up.
(20:50):
Well I think one thing to really think about here is that you know how much these policies impact the whole healthcare system you know when people fall off Medicaid coverage because they're not able to prove that they're working or or that they meet a caregiver exception or some other exception when they lose.
So they're health coverage because of that you know that that means instability for the whole healthcare system that we all rely on right the hospitals now have to see more patients that don't have insurance to pay the bills right and so there's a lot of.
(21:27):
So research around the importance of Medicaid coverage and keeping hospitals open keeping clinics open you know just it's the backbone of the healthcare system and when we make choices either cutting federal Medicaid dollars or putting in work reporting requirements and we're really making choices that are jeopardizing the health of the healthcare system and jeopardizing hospitals that make clothes and return to rewards that clothes or clinics that clothes.
(21:54):
So whether you're on Medicaid or not you rely on those you know you rely on the healthcare system being robust and working right and so we have to remember how important Medicaid is is a backbone for all of that and so I think the work reporting requirements place a particular burden on on individual people to report their work hours but but really you know anybody you should be thinking about this as a cut to the program just like any other cut to the program that really jeopardize.
(22:23):
The health of the healthcare system around us as a whole so people who are might be thinking hey I have private insurance this doesn't impact me all be fine really should be concerned too because there may not be.
A hospital for them to go to with their private insurance is that right there might be close when you travel to other areas of the country that have lower Medicaid enrollment rural areas where hospitals have already closed you know you.
(22:52):
Even if you live somewhere where there's hospitals that are open you want to travel you want to see our beautiful country you want to go to you want the healthcare system in our country to be serving all of us and so Medicaid is so critically important for that so.
You know we shouldn't forget that so people really really should be paying attention to all types of Medicaid cuts including this particular one that puts a lot of burden on on individual people who are eligible for Medicaid and need Medicaid to keep them keep them healthy and keep them working and they're and their caregivers to when you think about how important it is for caregivers to have the health care that they need to keep them healthy and doing what they need to do.
(23:35):
Yes and that's what we all want we all want to to provide care as much as our loved one needs it and.
We might not be able to do that if we don't have healthcare ourselves or healthcare for our loved ones when it comes to outside services beyond ourselves so.
Thank you very much for for discussing this this issue I will.
(24:01):
Would you also like to mention where people could connect with you.
You know I would say one thing is that especially in the work requirement discussion having stories from caregivers who say you know this is going to impact me and here's how those those stories really matter I think it's hard to connect your personal story to.
I'm larger healthcare financing debate in Congress but here thinking about how are you going to report your caregiving hours how are you going to meet this exception how are you going to survive without Medicaid you know those questions those individual stories are so so helpful so that's one way that I would encourage people to connect with families USA as one place that is happy to collect those stories so that we can.
(24:44):
And you know show lawmakers the impact that their that their policies have and use kind of personal stories and voices those really make a difference but those stories matter at the state level as I said states are making these decisions it's not just Congress so I'm not forgetting the kind of power of voices and and stories to say you know this impacts lots of people but it impacts me as a caregiver for my children for my loved ones for my elderly parents those stories really matter so.
(25:13):
You know something I can send you Lisa in the show notes is you know our story bank and some of our advocacy toolkit materials of people are filling client to.
Right letters to Congress or call in and talk about how important these issues are.
Excellent so that would be a wonderful way for people to connect on this issue and with our group that's really trying to fight along with so many others in in keeping Medicaid whole and and there for those that need it.
(25:40):
Yeah I think there's a lot of folks who would love to see those examples of how to write to a legislator.
Yeah and whole tool for that that kind of information is is is so valuable thank you this is love doesn't pay the bills I'm Lisa Chuty if you appreciate the podcast please tell a friend.
(26:02):
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