A Trump administration appears in the form

A
recent rollout in policy change from the Trump administration appears in the
form of pressure on states to mandate work requirements for recipients of
Medicaid.  The presidential support seeks
to reduce the number of “able-bodied” individuals utilizing the Medicaid
system. Kentucky, the first state to pass such eligibility requirements, faces
legal questions from several groups including recipients at risk of losing
their coverage (Medicaid 1115 Coverage Waivers, 2018). The Medicaid system in states
like Kentucky is overburdened and clearly something must change, but a mandated
work requirement doesn’t seem to quite hit the mark.   

            Prior to the expansion, the Medicaid
system was primarily utilized by pregnant women, children, elderly, and the
disabled who were uninsured without means of attaining affordable health
coverage. The passage of the Affordable Care Act, under the Obama administration,
allowed states to expand the Medicaid system with 33 states taking advantage of
this prospect (“A 50 State Look,” 2018). Gaps in coverage for the uninsured or
underinsured virtually disappeared, promoting equal access to healthcare
coverage and attainable healthcare for all Americans.

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Today Kentucky, a state overwhelmed by
people who sought Medicaid coverage through the expansion, has forecasted an
inability to fund such an expanded program into the future (The Associated
Press, 2018a). As a result, Governor Matt Bevin has resolved to mandate,
“having a job or volunteering for community service a requirement for receiving
government-funded health insurance” (The Associated Press, 2018a). This
first-of-its-kind change also implements income-based premiums and
re-enrollment requirements that if unmet, could mean a period of six months
“lock-out” (Reuters,2018b).

            In response, a class action lawsuit
was filed in federal court by a faction of Kentucky Medicaid recipients (Reuters, 2018b). The group states that the
U.S. Department of Health and Human Services, “exceeded its authority under the federal Medicaid law when it approved Kentucky’s
requirements earlier this month” (Reuters, 2018b). With unpredictable employment, and irregular income,
“the plaintiffs said they risked losing coverage under Kentucky’s new program” (Reuters,
2018b). Unstable financial situations as these,
also yield the possibility that recipients who are eligible for the program
won’t be able to afford the premiums and end up “locked out” (Reuters, 2018b). Some experts support the claim of this group of
Kentucky plaintiffs explaining that, “Medicaid’s goal of providing insurance to
those who cannot afford it,” is not promoted through requirements to work
(Reuters, 2018a). 

            The strength
of this radical change to Medicaid eligibility is the potential for federal and
state savings in the long-run, but the bigger picture doesn’t seem quite that
simple. What will states do to increase availability of jobs and job training?
Will education be more accessible and affordable for all? What kind of state
improvements will be made to meet the needs of families who can’t afford
childcare or transportation? Will individuals/families be able to find
employment that provides affordable insurance thereby reducing their need for
Medicaid? The answers to these questions, and the unproven correlation between
work mandates and reduced spending on Medicaid are shaky at best.