Democratic reps fire back on Medicaid work requirements, saying they would push low-income families out of coverage
Democratic representatives called the loss of health coverage the "perverse result that even the proponents of these new requirements should oppose."
Expressing "grave concern" over Medicaid work requirements' potential effect on low-income families and loss of health coverage, Democratic Representatives Elijah Cummings, ranking member of the Committee on Oversight and Government Reform, and Raja Krishnamoorthi, ranking member of the subcommittee on Health Care, Benefits and Administrative Rules, penned a strongly worded letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma demanding information on how work requirements will affect low-income families, how CMS plans to safeguard their health coverage and whether the work requirements violate Title VI of the Civil Rights Act.
In January, the Centers for Medicare and Medicaid Services told state Medicaid directors the agency would support state efforts to test incentives that would require work or "other community engagement" for continued Medicaid eligibility or coverage for certain adult beneficiaries in authorized demonstration projects.
Eleven states have submitted work requirement proposals for CMS review and others, including Oklahoma and South Carolina, are drafting their own proposals. Upon passage of the Affordable Care Act, Congress authorized the expansion of Medicaid eligibility to those making up to 138 percent of the federal poverty line and all but 17 states adopted Medicaid expansion.
Work requirements have been a much-touted caveat of healthcare reform by the Trump Administration but they have stirred controversy over potential adverse effects on beneficiaries.
Cummings and Krishnamoorthi wrote that work expansion proposals, especially those in non-expansion states, could mean lower-income families lose Medicaid eligibility and are simultaneously unable to afford private insurance, an outcome the two called the "perverse result that even the proponents of these new requirements should oppose."
They illustrated a hypothetical example in Mississippi, where parents or caregivers are eligible for Medicaid if their income is at or below 27 percent of the federal poverty threshold, or $467 a month. In the state, 91 percent of Medicaid beneficiaries are mothers and 71 percent are black.
Mississippi proposed a work requirement that would have beneficiaries working 20 hours a week, which at the state's minimum wage would have an individual earning $580 a month. This exceeds the state's Medicaid eligibility threshold by $113.
The earnings would be so small, the representatives wrote, that the individual would not be qualified for the ACA's premium tax credits, which were designed to make private insurance premiums more affordable for those who didn't qualify for Medicaid.
Under this framework, that individual would lose their health coverage, Cummings and Krishnamoorthi wrote.
Despite the state having since revised its proposal to allow some parents to temporarily remain on Medicaid, the state's own calculations show that 20,000 low-income parents, many of whom are black mothers, would still lose Medicaid coverage over the next five years under the state's revised plan, the letter argued.
"The disproportionate impact these coverage loses will have on black mothers in particular raises serious concerns that may implicate Title VI of the Civil Rights Act, which prohibits discrimination on the basis of race, color, and national origin in programs and activities receiving federal financial assistance," the letter said.
Cummings and Krishnamoorthi asked CMS to produce documents that show the impact of work requirements on coverage for low-income citizens; how the Administration will ensure coverage for those slated to lose benefits because of work requirements; and whether work requirements violate Title VI.
They are also seeking records of communications pertaining to various aspects of work requirements between Administration officials, states and outside groups or individuals. Cummings and Krishnamoorthi set a deadline for those documents and communications records of September 6.
Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com
