Medicaid Work Requirements and Families:

5 Facts you need to know

April 20, 2018 / Author: Anna Walton

On Thursday, April 19 the Tennessee General Assembly passed a bill that threatens healthcare access for the 1.5 million children, parents, and disabled Tennesseans who depend on TennCare (Tennessee’s Medicaid program). This bill (SB 1728/HB 1551) directs TennCare to submit a waiver to impose “reasonable” work requirements upon able-bodied working age adult enrollees without dependent children under the age of six. While the bill is now on its way to Governor Haslam’s desk to be signed into law, there is still some confusion about who will be impacted by this bill and the practical implications for Tennessee.

Here are five facts you need to know about Medicaid work requirements.  

1. In Tennessee, almost all adults ages 19-64 without federally qualified disabilities that receive Medicaid are low-income parents and caregivers.

The highest income parents (in a family of two, a child and a single parent) enrolled in TennCare can make is $1329 a month, or $15,948 a year. The only exceptions would be former foster children up to the age of 26, pregnant women (soon-to-be parents) or women with breast or cervical cancer. But these groups must still have low-income to qualify for Medicaid.

The vast majority of TennCare recipients are children, parents or other caretaker relatives, seniors, and people with disabilities.

Among this limited population of people who receive TennCare, who would be required to work to keep their care?

According to the bill language, ALL “able-bodied working age adult enrollees” including parents whose children are age 6 and older would be required to work 20 hours a week. There are no specific exemptions outlined.

Under the work requirement, there are two ways to stay covered by TennCare:

  • by fulfilling the requirement consistently AND proving it to the state consistently, or
  • by being categorically exempted in a way that you can prove

Now there is confusion about who would be exempted. The bill sponsors have contradicted each other as to whether there will be an exemption for the parents of children with disabilities (age 6 and older), who are not explicitly exempted in the bill. It seems that the sponsors of the bill are deferring to TennCare to work with CMS to decide on exemptions.

Let’s look at who is exempt in Kentucky, the first state to have work requirements approved:

KY enrollees can seek good cause exemptions if they can verify one of the following in their month of noncompliance:  disability, hospitalization, or serious illness of enrollee or immediate family member in the home; birth or death of family member living with enrollee; severe inclement weather including natural disaster; family emergency or other life-changing event such as divorce or domestic violence. In addition, 1 primary caregiver of a dependent minor child or adult with disabilities per household is exempt, and caregiving for a non-dependent relative or another person with a disabling medical condition is a work activity in KY.

For more information on CMS guidance and other states with approved waivers, Kaiser Family Foundation has a Medicaid Waiver Tracker.

If Tennessee adopts all of these exemptions (without even questioning how difficult and costly it would be to taxpayers to verify each of these complicated exemptions), how many TennCare recipients would be subject to the work requirement? How does the amount of savings created by cutting this small group off of TennCare compare to the expense and bureaucratic burden of administering the requirements for the whole TennCare population?

Does it worry our elected officials that someone who works could lose their coverage because their employer didn’t give them enough hours that week?

And if someone does fall into an exemption category, wouldn’t Tennesseans with the most health issues have an even harder time making sure they are proving that they are working or proving that they can’t work? Is their access to life-sustaining healthcare something we should take away from them because of a missed deadline?

Since every state to impose work requirements so far have expanded their Medicaid programs to cover childless, able-bodied adults who aren’t caring for a relative with disabilities, and TennCare does not cover these people, is it even logical to impose work requirements in Tennessee?

2. Most Medicaid recipients that can work do.

Not all jobs guarantee health insurance. In fact, less than half of all businesses in Tennessee offer healthcare. The top industries with the highest rate of workers covered by Medicaid are: Restaurant and food services, construction, elementary and secondary schools, grocery stores, hospitals, department and discount stores, home health care services, services to buildings and dwellings, nursing care facilities, and child day care services.

In Tennessee, 75% of TennCare recipients are in working families. Everyone knows that health insurance is incredibly expensive, and many low-income workers may not be able to afford monthly premiums.

Many low-income workers, along with not receiving benefits, often face inconsistent schedules and hours that would make it harder for them to meet the rigid requirements and jeopardize their health insurance at no fault of their own.

Work requirements will likely cause working TennCare recipients to lose their coverage simply because of the added bureaucracy that having to report employment adds.

3. Kids are more likely to be uninsured or not get the care they need if their parents don’t have health insurance.

The research is clear: kids do better when their parents have insurance. Although we’ve made great strides in Tennessee, approximately 53,000 kids are uninsured in Tennessee.

Even more than that, 183,000 kids in Tennessee have uninsured parents. This is correlated with lower wellness visits. The more access to care that a family gets, the better the family does, and our whole state benefits when families thrive.

4. Medicaid makes it easier to work.

A main reason for CMS pushing work requirements is the correlation of better health and higher employment. This correlation more likely reflects that the healthier someone is in the first place, the more likely they are to work. Research shows that the causation actually goes in the opposite direction; once someone has health insurance, they are more likely to work. Since Medicaid does not provide cash assistance, it is irrational to argue that depriving people of Medicaid would encourage them to work.

It’s common sense—parents will be more likely to get and keep a job when they are getting the health care they need for chronic and acute issues. Isn’t it much better for employees to have the security and peace of mind to know that if anything happened to them, they can receive medical treatment without risk of bankruptcy or losing their house? Medicaid expansion has reduced medical bankruptcy drastically.

5. Medicaid work requirements would hurt families.

Work requirements would force parents – working or not – to prove that they work or volunteer 20 hours each week. Medicaid is NOT welfare but a health insurance program for low-income Tennesseans that gives them the opportunity to go to the doctor if something is wrong or to manage a chronic condition. The healthier our population is, the healthier our economy is. How does requiring free labor or low-wage work benefit parents or the children they are raising when oftentimes that work will not justify the cost of child care? Many parents that stay home – even middle and upper-class parents – are doing it for the best interest of their child. Why are we limiting personal freedom with an overly punitive policy that does not help citizens work?

If our state legislators want to have a conversation about work, we welcome it. But this bill isn’t about work; it’s about making sure people lose their coverage.

It’s a (poor) solution seeking a problem. There are plenty of other problems our government should be focused on, like lowering the cost of health care and increasing access to care.

We are moving in the wrong direction when policy adds more red tape and costs taxpayers more dollars to insure fewer people.

Is our time and money best spent adding unnecessary red tape that makes it harder for eligible people to keep their insurance?

At the very least, we should wait and see if this works in other states first. It will be a natural experiment, similar to the one where other states with Medicaid expansion have seen boosts to their economies and increases to healthcare access, whereas Tennessee has turned a blind eye.

Read TJC’s full policy brief here.

More: TennCare Eligibility Tools and Toolkits