DHHR considering work requirements for Medicaid recipients

CHARLESTON, W.Va. — The West Virginia Department of Health and Human Resources is considering adding work requirements to the Medicaid program.

Jeremiah Samples, deputy secretary of the state DHHR, said Friday that state officials are considering whether to add work requirements for about 170,000 West Virginians covered by Medicaid expansion. He said the requirement, if enacted, would focus on able-bodied people.

Trump administration officials have criticized the Affordable Care Act, which brought Medicaid coverage to more able-bodied people, and encouraged states to implement work requirements for those people.

Medicaid expansion, a component of the Affordable Care Act, allowed states to expand the Medicaid program to people who made less than 138 percent of the poverty level. Prior to the Affordable Care Act, also known as Obamacare, the Medicaid program mainly helped people with disabilities, people with children and older people.

Samples said the idea is to pool resources and “align” Medicaid with food stamp programs and unemployment programs within the DHHR that already have work requirements. He said he didn’t have specifics on how that would work yet, noting the idea is still in the research phase.

He said the Temporary Assistance for Needy Families program already has existing relationships with programs that get people back to work, but fewer than 20,000 people in the state are covered by the program.

The U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services, since the Trump administration took over, has said Medicaid expansion means states are no longer prioritizing “the most vulnerable population,” or traditional Medicaid recipients.

In a letter to governors, administration officials said they would look favorably upon states’ requests to implement work requirements.

They encouraged states to submit 1115 waivers. Under Section 1115 of the Social Security Act, the secretary of the HHS can waive certain Medicaid rules.

Last week, CMS Administrator Seema Verner also encouraged, in a speech to Medicaid directors, “proposals that promote community engagement and work activities,” according to a news release.

Families USA, a consumer advocacy group, reported that several states have recently requested waivers to implement work requirements. The group supports voluntary programs that help people find work instead.

The group argues that the HHS secretary can only waive requirements, not create new ones (namely implementing work requirements), and that work requirements don’t move people out of poverty.

Renate Pore, a longtime health policy advocate who has been director of the Governor’s Health Care Planning Commission and the Governor’s Cabinet on Children and Families, said adding work requirements would increase administrative costs — creating “lots of extra paperwork.” She also predicted the policy could increase the cost of uncompensated care at hospitals.

“If health care is a human right, how can you say we’re not going to give you health care if you’re not working?” she said. “I think work is important for people, but I don’t think we should be doing it by withholding health insurance.”

About 50,000 of the people covered by Medicaid expansion have substance abuse diagnoses. Pore also noted other mental health problems might prevent someone from working who still appears to be able-bodied.

“A lot of people just have a mental or physical weakness that keeps them from being as responsible as we all would like them to be,” she said.

Samples said the DHHR wants to allow volunteer work, job training and education to meet the requirement. He also said the DHHR would allow exclusions — perhaps the enrollee is injured or treatment for addiction prevents him or her from working, he said.

“We’re still building this out,” Samples said. “If folks have ideas on how we can get folks into the workforce, we want to hear those ideas and really … this is not — we’re not trying to hurt anyone, and we’re not trying to stigmatize anyone.

“We really are just trying to help people — honest to goodness. I don’t want people to interpret this as we’re trying to crack down on some stereotype. We’re really trying to get people to work to help them. I think we can do a better job of that if we leverage our programs — both health and human resources.

“A person is not just a Medicaid person. They’re not a SNAP person. People are people, and they have holistic needs. And we need to troubleshoot their issues in a holistic way.”

Pore said she understood the DHHR was under pressure from legislators.

Samples said he recently presented the idea to some members of the Legislature. He said, while “there are certainly legislators that are interested in work requirements programs … this is something that we’re also looking at just as part of our responsibility to our members.”

“If someone is struggling to find a way to get back into the workforce, we have a responsibility to troubleshoot that and help them get back into the workforce,” he said. “That’s why we want to align the three programs — to utilize our resources as efficiently as possible.”

Samples said the DHHR anticipates it will submit a waiver application next calendar year. They are studying other state programs.