Work Requirement for Medicaid—Will This Idea Fly in Illinois?

By Beverly George

ACE-Naperville Leader


It seems there are always plenty of “Breaking News” stories at the end of the week, and many have wider, more immediate, and more personal impact than Mr. Trump’s most recent tirade with expletives.

Last week was no exception when the Center for Medicare and Medicaid Services issued guidelines allowing states to develop and test programs that would require able-bodied adult Medicaid recipients, between ages 19 and 64, to participate in at least 80 hours of “employment activities” per month. In addition to paid employment, these activities would include job training, education, and community service. Ten states so far have welcomed this policy change: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin.

Kentucky’s waiver was submitted for approval the first time back in 2016, and in addition to the 80 hours per month of “employment activities” required of recipients, the plan would also impose a premium based on income level. Those who would miss a payment or fail to re-enroll would be locked of the program out for six months. Keep in mind that according to the Kaiser Family Foundation, 60% of adult Medicaid recipients across the nation have jobs. Most adult recipients who do not work reported one of these major barriers as the reason: a criminal record, homelessness, lack of education or training, an empty job market, no access to public transportation, or a disability that doesn’t meet the legal definition of disability.

Kentucky Governor Matt Bevin said on NPR last Friday that “Kentucky will now lead on this issue.” And speaking of current Medicaid recipients, he added, “They want the dignity associated with being able to earn and have engagement in the very things they’re receiving.”

The governor spoke with such conviction, I can only wonder if he speaks from his own experience.

However, Rep. John Yarmuth (D-KY) has been quoted as saying that he found the change “dangerous and irresponsible” and predicted it could result in tens of thousands of Kentuckians losing their health coverage.

The Chicago Tribune has reported Governor Bruce Rauner is reviewing the new guidelines, but it’s too early to tell if Illinois will follow the lead of neighboring states Wisconsin and Indiana. The Illinois Hospital Association and other patient advocate groups have made clear they hope Illinois does not join the ten states. Critics of work requirements say the fundamental purpose of Medicaid is to help low-income people access medical benefits, and they also claim work requirements would be based on the false claim that poor people are lazy and don’t want to work.

These opposing arguments remind me of the age-old question,: which came first—the chicken or the egg?

Do poor people seek work because they have received health care and are feeling stronger and more ready to engage? Or, should unwell people be forced to work or to meet similar requirements as a stipulation to access health care? To me, the discussion boils down to a very simple question. Don’t all human beings have a right to health care, regardless of their economic station or employment?

Kentucky Becomes First U.S. State to Impose Medicaid Work Provisions,” New York Times, 1/12/18.

“No work, no Medicaid? Illinois reviews new federal guidelines,” Chicago Tribune, 1/11/18.

Along with being the leader of ACE-Naperville, Beverly George also is a member of Indivisible, the Naperville League of Women Voters, and the Citizens Climate Lobby. She also volunteers with her parish PADS group. A former chemist, George worked in clinical chemistry and hematology research at the Centers for Disease Control for six years and taught chemistry and freshman science at Naperville North High School for 20 years.