Ohio Seeks To Impose New Medicaid Work Requirements, Tempting Lawsuits

NYC FEDERAL BUILDING AT 26 FEDERAL PLAZA, NEW YORK, NY, UNITED STATES - 2017/03/21: Protesters holding boxes with a print on it. Outside the NYC Federal Building (26 Federal Plaza, Bway between Worth and Duane), which contains Medicaid offices, hundreds of New Yorkers who rely on Medicaid, including seniors and people with disabilities, will conduct political theater to protest congressional Republicans' plan to remake Medicaid. (Photo by Erik McGregor/Pacific Press/LightRocket via Getty Images)
LightRocket via Getty Images

On Monday night, Ohio Gov. John Kasich (R) officially submitted a request to the Department of Health and Human Services for permission to force the roughly 700,000 people enrolled in the state’s Medicaid expansion to prove they’re working at least 80 hours per month. If the waiver is approved, Ohioans unable to find work would have to get placed with an organization in their county and work without pay to earn the value of their health care benefits.

Ohio’s non-profit Center for Health Affairs estimates that 18,000 people could lose  coverage due to the requirement, though advocacy groups say that number could be much higher if eligible people are deterred by the bureaucratic hoops they have to jump through to document their employment status or prove they’re exempt due to a disability.

“We believe they’re vastly underestimating,” Katie McGarvey with the Legal Aid Society of Ohio told TPM. “There’s not an automatic way to do those exemptions, so each county will have to contact each individual, get documentation, and do an assessment. What if the person doesn’t get the mail or doesn’t have transportation to the appointment? It’s a huge administrative barrier and a lot of people who need the exemption and are eligible will fall through the cracks.”

McGarvey says that if the waiver is approved by HHS, her organization is likely to sue.

“There are certainly grounds to litigate,” she said. “We argue that it goes against the purpose of the Medicaid statute, which is to provide health care to low-income individuals, not encourage work or personal responsibility or anything like that.”

McGarvey says the waiver may violate both the Administrative Procedures Act and the Fair Labor Standards Act.

Three states — Kentucky, Indiana and Arkansas — have already received approval from the Trump administration to implement Medicaid work requirements. Ohio is one of 11 states vying to be next. A group of low-income residents in Kentucky are currently challenging the rules in federal court, and the outcome of that case could determine the future of health care across the country.

Ohio’s proposal is unique, in that it would force thousands of people to work enough hours to earn the dollar value of their Medicaid benefits.

“If an individual isn’t working, they are sent to the county, and the county places them in different ‘work experience’ sites — usually a local charity or non-profit where they would do clerical work,” McGarvey explained. “They don’t get paid by the organization they’re placed at; they’re just earning enough to meet their benefits requirement. If you do the math, it doesn’t come out anywhere close to the minimum wage. It’s closer to $2 to 3 an hour.”

The Trump administration is likely to announce its decision on Ohio’s waiver in June. Ohio estimates that it would take six months after that to implement the work requirements program.

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