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Utah’s Medicaid fraud bill on hold after strong criticism | KUTV

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Utah is one of several states looking to reduce fraud in food stamps and related benefits programs, and Democrats oppose the effort.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Spending hundreds of dollars to chase pennies: That’s what critics worry a new Medicaid fraud bill would lead to and all on the taxpayer’s dime.

It’s a measure one opponent goes as far as to call potentially catastrophic for Utah.

Lawmakers in support of the bill said Tuesday they want a process to investigate people who improperly receive state benefits.

This is something those in opposition argue is a very minor problem in Utah. Alliance for a Better Utah, a nonprofit, watchdog organization, said instead of pouring millions of dollars into searching for a needle in a haystack, we should address the real issue–the high rate of uninsured kids in the state.

The legislation would make an already lengthy Medicaid waiver application process even more involved, which neither the Trump nor Biden administrations have ever supported.

Dave Gessel, a representative with the Utah Hospitals Association, said they were not consulted and strongly oppose this bill.

Opponents said this would do little more than make it extra difficult for people in need to get help. The bill is on hold for now and not expected to go anywhere this legislative session.


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With GOP Back at Helm, Montana Renews Push to Sniff Out Welfare Fraud | Kaiser Health News

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Montana is one of several states looking to reduce fraud in food stamps and related benefits programs, and Democrats oppose the effort.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



Montana is considering becoming the latest state to aggressively check welfare eligibility to cut costs. While supporters of the move say it’s about what’s fair, opponents say it will impact enrollees who need help, especially amid the pandemic. (Matt Volz / KHN)

Montana is considering becoming the latest state to intensify its hunt for welfare overpayments and fraud, a move expected to remove more than 1,500 enrollees from low-income health coverage at a time when the pandemic has left more people needing help.

With Republicans now controlling both chambers of the Montana legislature and the governor’s office, a lawmaker is reviving an effort to both broaden and increase the frequency of eligibility checks to search for welfare fraud, waste and abuse. Proponents say it’s about what’s fair — weeding out people who don’t qualify, protecting safety nets for those who do, and saving the state millions. But advocates for low-income people who rely on such services and some policy analysts say such changes would unfairly drop eligible people who need the aid.

“We’re not looking to do anything mean. We’re taking the emotion out of it,” state Sen. Cary Smith, a Republican, said during a Jan. 20 hearing on his bill, the Provide for the Welfare Fraud Prevention Act. “If you don’t qualify, then you shouldn’t be participating in that program.”

The Montana bill, and measures underway in Ohio and Utah, are similar to earlier efforts undertaken to cut costs in states such as Illinois and Michigan. But this year’s bills come even as Congress offers states more Medicaid dollars if they ensure people have continuous coverage through the pandemic because of its economic shock waves.

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The Montana proposal would create a system potentially run by third-party vendors that would mine a large swath of data to see if someone, for example, has assets like a boat, has won the lottery or has filed for benefits in another state. The vendor could earn a bonus for flagging more cases than the state projected. State employees would have the final say in cutting someone from Medicaid, the Children’s Health Insurance Program, food stamps or other aid programs.

The state estimates the measure could save Montana’s treasury between $1.4 million and $2.3 million each year over the next four years by dropping more than 1,500 people on Medicaid and 277 children covered by CHIP.

This isn’t Smith’s first effort to create such a law. He sponsored a similar bill in 2015 that was vetoed by the state’s then-governor, Democrat Steve Bullock. In the veto letter, Bullock said the measure duplicated steps the state already took and unfairly stigmatized Montanans who are poor. Opponents of Smith’s latest proposal have repeated those concerns. Smith didn’t respond to several requests for an interview.

But this time, the potential legislation has a clearer path. The state has a new governor, Greg Gianforte, a Republican who called for heightened Medicaid eligibility checks throughout his 2020 campaign.

During Montana’s first hearing for the renewed effort, Scott Centorino of Opportunities Solutions Project was the sole person to testify in support of the bill.

“I’ve seen this play out in state after state,” Centorino said. “Turns out, the less you look for welfare, fraud and waste, the less you find.”

Opportunity Solutions Project, the lobbying wing of the Foundation for Government Accountability, a right-leaning think tank, has backed similar efforts elsewhere that followed FGA model legislation. The organizations have also been major forces in trying to link food assistance to work requirements and block states from expanding Medicaid.

Opportunity Solutions Project’s attempts to influence laws at the federal level, too, appear to be growing. The nonprofit spent $25,500 lobbying the federal government in 2017 and $420,000 last year, according to the Center for Responsive Politics.

Opponents of the Montana bill have said the focus on welfare recipients is misplaced. Nationally, most Medicaid payments deemed improper last year were tied to states not collecting information that federal standards already call for, not necessarily for covering ineligible enrollees, according to a U.S. Department of Health and Human Services financial report.

Michele Gilman, a University of Baltimore law professor, said the potential bonus Montana would pay a company finding more savings than expected is especially concerning.

“The goal should not be to create some bounty hunter system to find alleged cheats that don’t exist,” Gilman said. “This is built on an unfounded mistrust of poor people and undermines public support for social programs.”

If states do move to undertake broad data searches, she said, they need to start with a pilot program to test for errors in its design. Gilman called Michigan the ultimate cautionary tale. The state, which had used a new computer program to spot cheaters, ended up mired in lawsuits after it falsely charged thousands with unemployment fraud between 2013 and 2015.

The Trump administration and federal agencies encouraged states to increase eligibility checks. According to a KFF analysis, as of January 2019 more than half of states were conducting checks more often than during annual renewals, with some doing so quarterly. (KHN is an editorially independent program of KFF.)

Robin Rudowitz, co-director of KFF’s Program on Medicaid and the Uninsured, said Medicaid and CHIP enrollment dropped across the nation from late 2017 through 2019. Rudowitz said it’s hard to untangle all the reasons the enrollment declines occurred, but increased verification efforts that add to administrative hurdles create barriers to coverage.

Jennifer Wagner, with the left-leaning Center on Budget and Policy Priorities, said people may not realize they’re still eligible when notified that their benefits are in question or may not even receive the notice. She said a search for benefits filed in a separate state may flag aid that can cross states, such as food stamps, and such searches can pull up property someone no longer owns. Frequent wage checks may not take into account inconsistent jobs. The onus would fall to the aid recipient to prove they are still eligible in each scenario, she said.

One state that Opportunity Solutions Project points to as a success is Illinois, which in 2012 hired a company to identify Medicaid recipients who might not be eligible. Wagner, who was an associate director with the Illinois Department of Human Services at the time of the change, said Illinois is unique because the state knew it had a backlog of status checks. Within a year, Illinois had canceled benefits for nearly 150,000 people. But the state reported that more than 75% of cancellations were due to clients’ failure to respond to a state letter asking for more information. Wagner said similar issues have occurred in other states.

“In many cases, those individuals remain eligible, but they have a gap in coverage and they have to reapply and do what they can to get back on the program,” said Wagner. “There’s a large cohort of people who never get that done.”

Of all the people Illinois dropped, nearly 20% had reenrolled by the end of the year. That issue — people getting knocked off when they’re eligible — already happens in annual renewals. But Wagner said more checks means more people losing benefits, and more work for states to bring those people back onboard.

Centorino, with Opportunity Solutions Project, said systems that remove qualified people aren’t being implemented properly, but added it’s not too heavy of a lift to respond to an eligibility question.

“The alternative is not is not resolving the discrepancy at all and just assuming that there is no discrepancy and continuing to fund benefits for somebody who may be ineligible,” he said.

In Montana, even with the bill’s clearer shot at becoming law, some elements that opponents criticized were rolled back after the state estimated it would need to hire 42 employees to run the new system. Smith reduced how many programs would fall under its scrutiny and pulled back eligibility checks to twice a year instead of quarterly. He removed a rule that the system pay for itself, and he cut a section that would have disenrolled people who don’t respond to eligibility questions or notices within 10 business days.

Nonetheless, if a new system flags issues in people’s enrollment, the state will have to go out searching for why. The bill is under consideration in the Senate and must also pass the House before it goes to Gianforte for signing.


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Montana Senate gives initial OK to more verification checks on assistance programs


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Montana is one of several states looking to reduce fraud in food stamps and related benefits programs, and Democrats oppose the effort.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Holly Michels

A bill that would have the state health department implement more methods of verifying the eligibility of those receiving benefits from public assistance programs passed an initial vote in the Montana Senate on Tuesday.

All the Senate Republicans backed Senate Bill 100, while all Democrats opposed it in a 31-19 vote.

The bill, carried by Sen. Cary Smith, R-Billings, would increase the ways the Department of Public Health and Human Services verifies people are qualified for several public assistance programs.

Beyond tax and wage data, the department would contract with a third-party vendor to also review arrest and incarceration information, immigration status, housing assistance payments, emergency utility payments, child care services information, information from external vendors such as LexisNexis and Equifax, and more.

Smith said the bill is meant to eliminate fraud in state-administered programs including Medicaid, Medicaid expansion, the Supplemental Nutrition Assistance Program, the Children’s Health Insurance Program and the Temporary Assistance for Needy Families Program.

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Iowa Senate bill would require added steps for Medicaid, food stamps

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Iowa is one of several states looking to reduce fraud in food stamps and related benefits programs, and Democrats oppose the effort.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



Iowans may soon need to undergo added verification steps, including checks of their household assets, to receive food stamps and other benefits.

The Senate approved the bill, Senate File 389, Tuesday night. It would also instruct the Iowa Department of Human Services to use a computer system to conduct automatic eligibility checks for Iowans on other public assistance programs including Medicaid. Senate Republicans say that step will streamline the process and reduce fraud. 

But Democrats said the measure would trip up needy Iowans seeking food assistance, which could be more painful given coronavirus-related needs. The additional computerization is also unnecessary, they said, because the state is already working on updating its system. 

The Iowa Senate passed the bill on a 30-18 party-line vote Tuesday evening but it faces an uncertain future in the Republican-controlled Iowa House, where similar “welfare reform” measures have failed to advance in past years. 

More:Iowa hunger-fighting organizations calling on Legislature for more support

Sen. Jason Schultz, R-Schleswig, who has introduced similar bills over the past four years, said the state has begun to recognize the need for computerization over the past few years. While Iowa DHS has been working on computerizing the system, he wants the state to go further. If it became law, he said Iowa would decrease its error rate for food assistance payments.

“We are moving in the right direction, but this bill would actually move us there quite a bit more quickly,” Schultz said.  

Democrats, however, said adding additional food stamp requirements such as an “asset test” would make it more difficult for Iowans in need.

“The more rigorous it is, the harder it is to sign up for, and I think it’s probably your intention,” Sen. Liz Mathis, D-Hiawatha, said Tuesday.

The nonpartisan Legislative Services Agency estimates approximately 1% of Iowans receiving benefits would see their benefits canceled due to discrepancies — equal to 5,999 Medicaid recipients, 793 Children’s Health Insurance Program recipients, 68 Family Investment Program recipients and 1,466 recipients of Supplemental Nutrition Assistance Program, often referred to as food stamps.

What the bill does: Computerizes identity checks for Medicaid, food stamps

If the bill becomes law, it would require Iowa’s Department of Human Services to either contract with a third-party vendor or establish its own computer system to conduct identity verification and other services for the state’s public assistance programs by July 1 of next year

The system would use a variety of federal and state records to verify eligibility of Iowans applying for assistance programs. 

If the state contracts with a third-party vendor for the service, the vendor would refer cases that don’t pass through to Iowa DHS. When Iowa DHS finds a discrepancy, the agency would provide written notice to the applicant, who would have 10 days to respond. 

COVID-19 assistance:How low-income Iowans can get help with overdue utility and rent bills

A failure to respond in a “timely manner” would result in termination of benefit enrollment. Iowa DHS would refer suspected fraud cases to the Iowa Department of Inspections and Appeals for review.

“It does not give third-party vendors any opportunity to kick anybody off,” Schultz said during a subcommittee meeting last week. “All it is is a tool — a high-tech, efficient tool — for DHS to scrub the eligibility (of) the list of recipients and find those who don’t fit in.” 

Schultz said he believes “85% to 90% of recipients would slide through” the system without needing to provide any additional documentation. 

Bill requires ‘asset test’ for food assistance

Schultz’s bill would change eligibility determination for the Supplemental Nutrition Assistance Program. Under the bill, Iowans would need to pass an asset test before qualifying for food assistance.

An asset test calculates the value of an applicant’s possessions — including bank accounts, real estate and secondary vehicles — to determine the person’s eligibility.

The asset test would be a departure from current practice. 

Iowa is among the states that allow people to qualify for SNAP benefits through “broad-based categorical eligibility,” which allows people who already qualify for other specified programs to receive food stamps. Iowans who qualify under categorical eligibility currently do not need to undergo an asset test, but the bill would change this.   

Overall, the bill would cost the state money up-front but reduce costs in future years, according to the nonpartisan Legislative Services Agency. A report estimates the bill would increase state costs by $1.5 million next fiscal year but save the state $11.8 million per year after that. 

Critic: Measure is ‘creating more barriers and kicking people off programs’

Senate Republicans and the groups Americans for Prosperity, Iowans for Tax Relief and the Opportunity Solutions Project support the bill, saying it will increase efficiency and trust in the state’s government.  

But several local service agencies and health care groups oppose it. They say the moves might knock people off the program who aren’t native English speakers, who struggle with financial literacy or who aren’t tech-savvy. 

“At a time when we’re seeing increased levels of food insecurity across the state of Iowa, we should really be exploring ways to increase access to food assistance benefits, not creating more barriers and kicking people off programs for which they’re eligible for,” said Luke Elzinga, the communications and advocacy manager with the Des Moines Area Religious Council Food Pantry Network, said during a subcommittee meeting last week. 

Hunger in Iowa: How to find help if you need food assistance

Elzinga said he’s concerned about the asset test for food stamps. Among the assets that count toward the limit are second vehicles, which he said could disqualify families who need more than one vehicle for work, especially in rural areas.

Critics have also said the moves are likely redundant. Janee Harvey, the Iowa DHS division administrator of Adult, Child and Family Services, told lawmakers at last week’s subcommittee hearing the department is “meaningfully engaged in these activities already.”

The state is preparing to comply with federal requirements to participate in the National Accuracy Clearinghouse — a national system meant to prevent people from receiving food assistance in more than one state — by December, she said. The state is also considering a one-year free trial of an income verification product through Equifax, she said. 

Democrats on Tuesday introduced three amendments, including one that would have eliminated the food stamp portion of the bill, and another that would have instructed Iowa DHS to compile a list of the employers of Iowans on Medicaid.

Multiple Democrats on Tuesday pointed to the increase in food insecurity during the COVID-19 pandemic.

“I’m sure there’s a bill coming afterwards to fund soup kitchens and food banks because right now we’re overwhelmed,” said Sen. Amanda Ragan, D-Mason City, who directs the Community Kitchen of North Iowa and Mason City Meals on Wheels. 

Schultz said Democrats are blowing many of the concerns out of proportion. The intent of the bill is not to save money by kicking eligible people off of benefits, he said.  

Schultz told the Des Moines Register last week that he’s optimistic the public assistance oversight bill will receive more consideration in the House than in past years.

This year, Republicans widened their majority in the House to 59-41, picking up six seats. 

“Every single year, I feel better,” he said. “The idea itself is becoming normalized.” 

Ian Richardson covers the Iowa Statehouse for the Des Moines Register. Reach him at, at 515-284-8254, or on Twitter at @DMRIanR.


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Benefits Rollback Bill Would Cost Nearly $20 Million in Red Tape, Analysts Say

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Ohio is one of several states looking to reduce fraud in food stamps and related benefits programs, and Democrats oppose the effort.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


The Ohio Senate bill reportedly would curb fraud, but a 2015 investigation found that fraud amounted to less than 1% of administered SNAP benefits and less than the cost of the audit itself.


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Two lines of cars wait for food assistance at the All People’s Fresh Market in Columbus. Officials say covid-related food insecurity is growing in Ohio.Photo: Marty Schladen, Ohio Capital JournalA legislative proposal to restrict eligibility for social safety net programs like food stamps or Medicaid would cost nearly $20 million to implement, according to state policy analysts.

The Ohio Legislative Service Commission, a nonpartisan arm of the state legislature that evaluates policy proposals, estimated a plan to require photo identification on every Supplemental Nutrition Assistance Program card would cost about $15 million to implement and $930,000 annually to maintain.

Senate Bill 17 would end policies known as “categorical eligibility” and “simplified reporting” that lower income reporting burdens on SNAP recipients along with the bureaucratic burden on state government. The new, more onerous income reporting system would cost about $4.5 million to implement, according to the LSC.

The bill’s lead sponsor, Sen. Tim Schaffer, R-Lancaster, said the bill is a means to combat benefits fraud and ensure monies only go to the truly needy.

On Tuesday, food bank operators, the counties’ Ohio Department of Job and Family Services association director, anti-poverty advocates and others urged lawmakers against cutting the social safety net during a still-raging pandemic that has destabilized the economy and increased unemployment rates.

They said more paperwork requirements on top of an already cumbersome application process would cause needy families to slip through the cracks.

“The bill, as it’s currently presented, wants to spend tens of millions of dollars,” said Lisa Hamler-Fugitt, executive director of the Ohio Association of Foodbanks, to lawmakers.

“It does not provide one additional dime of food assistance.”

SB 17, if passed, would:

  • Impose asset tests on SNAP (often known as food stamps) recipients. They would not qualify for benefits if they have more than $2,250 in cash (a measurement that includes all value of a vehicle above $4,650). The program is currently available to people earning below 130% of the federal poverty line.
  • Impose a new work or education requirement to receive benefits through Medicaid, a federal and state-funded health insurance program that covers costs of care for people who are poor, elderly, disabled or pregnant.
  • Restrict exemptions to the Medicaid work requirement, including raising the minimum age to opt out to 65 from 55.
  • Switch from the current “simplified reporting” system (SNAP recipients need not report small weekly income changes so long as they don’t surpass the eligibility threshold) to “change reporting” (recipients must notify ODJFS of income changes, no matter how small, from things like overtime).
  • Eliminate “broad based categorical eligibility,” which automatically qualifies recipients of one benefit system like SNAP for others like Temporary Assistance for Needy Families.


The bulk of the costs under the bill stem from the $13.1 million needed for information technology to build a new system for a photo ID system on SNAP cards, plus $2 million to issue an estimated 500,000 cards, according to the LSC. The new system would cost $930,000 per year from there.

The state and federal government split the administrative costs of SNAP, while the federal government pays all the program benefits.

Eliminating categorical eligibility would incur a $2.8 million, one-time cost, according to LSC. Eliminating simplified reporting would cost about $1.5 million.

“In addition, these changes will likely pose significant administrative costs for county departments of job and family services, which are responsible for determining SNAP eligibility for applicants,” the analysis states.

In December, about 1.55 million Ohioans received an average $233 in monthly assistance via SNAP, according to ODJFS data, which comes out to about $7.50 per day.


Organizations combatting hunger, homelessness and poverty in Ohio panned the proposal.

“Reducing access to SNAP and Medicaid will harm the health of low-income Ohioans and push even more into homelessness,” said Bill Faith, executive director of the Coalition on Homelessness and Housing in Ohio, in written testimony.

“Ohio simply cannot afford the damage that would be caused by Senate Bill 17.”

Matt Habash, president of the Mid-Ohio Food Collective, said since the pandemic began, more than 56,000 families sought out meals from the collective for their first time.

“The changes to SNAP and Medicaid eligibility in Senate Bill 17 will — without question — increase food insecurity and force more Ohioans to turn to organizations such as ours for the most basic of needs —  food,” he said.

Other groups like the American Cancer Society and the American Heart Association submitted testimony against the bill, as did the Ohio Council of Churches, Equitas Health and more.


Fraud exists within the SNAP system, but there’s little evidence of it occurring at scale.

During the hearing, lead sponsor Sen. Tim Schaffer, R-Lancaster, cited a 2016 report from the Dayton Daily News about $17 million in fraud identified over five years in Butler County. Officials reportedly broke up a SNAP-cards-for-cash operation.

On a statewide level in 2017, ODJFS investigators identified 2,465 instances of fraud worth about $4.5 million — about .2% of the roughly $2.2 billion in benefits administered that year (the most recent with data available).

2015 investigation from the state auditor identified similar, limited instances of fraud within the SNAP program like benefits being claimed from dead recipients. The identified fraud amounted to less than 1 percent of administered benefits and less than the cost of the audit itself.

Several of the bill’s critics questioned why lawmakers are targeting fraud in SNAP or unemployment benefits as opposed to the Pandemic Unemployment Assistance program, a newly created federal program apparently bilked for hundreds of millions by criminal scammers.

The committee did not vote on the bill Wednesday.

This story was originally published by the Ohio Capital Journal and republished here with permission.


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Fewer people will get food, Medicaid, unemployment under Ohio bill requiring more fraud checks, advocates say


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Ohio is one of several states looking to reduce fraud in food stamps and related benefits programs, and Democrats oppose the effort.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Ohio Sen. Tim Schaffer is holding pictures of what he said shows SNAP cards that were found in drug houses. Schaffer is sponsoring a bill that seeks to decrease fraud in Ohio social services, but advocates for the poor say the extra checks and verifications would cut people off services.

COLUMBUS, Ohio – An Ohio Senate bill that seeks to catch fraud among people applying for and receiving social services will result in increased work for county case workers, as well as fewer low-income people obtaining food aid, Medicaid and unemployment benefits, advocates for the poor said Wednesday.

Senate Bill 17 requires case workers to cross-check applicants and enrollees against state data such as new hire records, wage records, lottery winnings and death records, said sponsor Sen. Tim Schaffer, a Lancaster Republican.

Schaffer held up pictures during Wednesday’s Ohio Senate Government Oversight and Reform Committee of food aid debit cards he said were found by investigators in drug houses. He said catching the fraud is important because it’s taking benefits away from those who need it.

Some of the most sweeping changes in SB 17 would be in SNAP, the Supplemental Nutrition Assistance Program.

SB 17 would require color photo identification of at least one adult in every household on Ohio Direction cards, the debit SNAP card.

SNAP recipients would also be subject to more rigorous asset maximums. Generally, a household’s liquid assets would have to fall below $2,250, or $3,500 if the household has an elderly or disabled member. A vehicle could be worth up to $4,650. Such limits do not currently exist in the program.

“If you’re a family in need and you have a car at home which you use to get to work, but you are having a hard time affording groceries for your family, you’ll be forced with the decision: Do you sell your vehicle, which you use to get to work, or do you keep the food from the stomachs of your kids, which is an impossible decision for a parent to make,” testified Kimberly LoVano, the Greater Cleveland Food Bank’s director of advocacy and education, at the committee meeting.

To continue to be eligible for SNAP, households would have to report changes in income within 10 days of learning of the changes, which is not currently required.

LoVano argued that reporting income changes is not reasonable in the cases of people who work in retail or food service. They constantly pick up or lose shifts each month.

“I can tell you fluctuation of one to two shifts a month is the norm, not the exception,” she said.

Other changes in SB 17 would again force Ohio Medicaid to require many recipients of the joint state and federal health care program to work or go to school part-time. Work requirements need federal permission to implement. Ohio Medicaid had received an OK to develop them, but with the pandemic they were delayed. Then President Joe Biden’s administration said it would rescind all state work requirements.

Most of the changes to unemployment would require checking prison records to ensure people who are applying for benefits weren’t recently incarcerated.

Lisa Hamler-Fugitt, executive director of the Ohio Association of Foodbanks, told lawmakers her colleagues in other states are fighting the exact same bill. It’s backed by the Foundation for Government Accountability, a conservative-leaning group. Hamler-Fugitt believes the ultimate goal is to weaken social safety net programs.

Sam Adolphsen, a visiting fellow with the Foundation for Government Accountability’s Opportunity Solutions Project, testified to the committee on Feb. 10.

“Senate Bill 17 is a practical and principled bill. It is comprehensive, but it is also a straightforward piece of legislation that establishes best practices and commonsense safeguards,” he said. “The bill is practical because, right now, Ohio faces a serious crisis. The pandemic and shutdown have created havoc for the Ohio economy and state budget. That challenge, made worse by federal changes that bind your hands, has thrown your benefits programs into chaos.”

Hamler-Fugitt, on the other hand, said that SB 17 is overly broad, when the real fraud problem is with pandemic unemployment benefits. Last year, Ohio paid out $330 million in fraudulent claims. Experts say much of that fraud is being perpetrated by sophisticated scammers, often from outside the country.

“Our problem right now is with the unemployment compensation system,” she said. “I’m pleading with you: Do something about where we are hemorrhaging resources now.”

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More than 405,000 Hawaii residents now on Medicaid after record-setting job losses


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Hawaii’s Medicaid enrollment has surged 24% during the pandemic.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


HONOLULU, Hawaii (HawaiiNewsNow) – The number of Hawaii residents on Medicaid, the government’s health insurance program for low-income adults and children, has soared by 24% amid the pandemic as the state saw record-setting job losses.

Ahead of the pandemic, there were 327,199 Hawaii residents on the state’s Medicaid program, Med-Quest. Last week, there were 405,598, a dramatic increase that demonstrates the impact COVID shutdowns and job losses had on workers and their families who lost health insurance, too.

Every county saw a jump in Medicaid recipients.

Honolulu had the most new applications. But percentage wise, Maui saw the biggest increase of 50%.


Increase in Medicaid enrollment since pandemic (Source: None)

Even as the economy has reopened, the numbers continue to climb.

“None of us could have predicted this at the beginning of the pandemic, but the longer it’s gone on and the more we’ve seen families continue to struggle, it’s not unexpected,” said Judy Mohr Peterson, administrator of the State’s Med-Quest Program.

Medicaid is funded using both federal and state dollars. The federal government has increased contributions to keep up and the state is looking to add money to the program, too.


Increase in Medicaid enrollment since pandemic (Source: None)

“We’re in frequent conversations with the legislature and the Governor’s office on the budget situation and ways that we will be able to address the increased needs in the long run,” Peterson said.

To chip away at the budget challenge, a bill that would impose new fees on for-profit health insurance companies is moving through the state Legislature.

But the shortfall could continue if the numbers don’t start to go down soon.


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New York lawmakers, advocates dismayed by Cuomo administration’s proposal to cut Medicaid reimbursements



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NY lawmakers are considering a 1% cut to Medicaid funding.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

A patient wears a protective face mask as she is loaded into an ambulance March 18, 2020, at The Brooklyn Hospital Center emergency room in New York. Anticipating a spike in coronavirus patients, New York City-area hospitals are clearing out beds, setting up new spaces to triage patients and urging people with mild symptoms to consult health professionals by phone or video chat instead of flooding emergency rooms that could be overrun.

John Minchillo / AP photo

(The Center Square) — While the COVID-19 nursing home scandal that has plagued the Cuomo administration drew a lot of attention at Thursday’s legislative budget hearing, New York state lawmakers still had time to pepper administration officials on what’s being proposed for the year ahead. And a proposed 1 percent cut in the Medicaid budget certainly caught the eye of some legislators as well as other advocates.

The Healthcare Association of New York State called on the Legislature to reject the cut, noting that the public insurance program currently only reimburses providers at a rate of 67 cents for every $1 of care given.

“While it is never a good time to cut state support for healthcare, this year it would be devastating. … Further deterioration of that support – especially as we work to end and recover from the pandemic – would worsen an already fragile safety net system and put patients at risk,” Healthcare Association President Bea Grause said in written testimony.

The proposed cut in Medicaid funding comes as the state faces a multibillion dollar deficit it needs to fill. While Gov. Andrew Cuomo has been hopeful the federal government will provide the state with $15 billion in direct funding to make the state whole, he’s noted that program would face cuts without help from Congress.

Lawmakers raised their own concerns, saying the cuts would be particularly hurtful to hospitals that primarily serve lower-income patients.

“If you cut 1 percent of Mount Sinai’s Medicaid allotment and 1 percent of, say, Elmhurst’s Medicaid allotment, that might sound fair to somebody who doesn’t know anything about our hospitals, but it obviously is not,” said state Assemblyman Richard Gottfried, D-Manhattan.

Health Commissioner Dr. Howard Zucker said the administration recognized that hospitals considered part of the state’s safety net were facing challenges even before the pandemic. Once COVID-19 hit and elective surgeries were curtailed, it only became worse.

Deputy Health Commissioner Donna Frescatore told the committee that the 2022 budget contains an additional $900 million for “financially distressed” hospitals.

Still, other lawmakers noted that the pandemic has caused more people to enroll in Medicaid. Senate Finance Committee Chairwoman Liz Krueger, D-Manhattan, pointed out that when the state implemented a cap on Medicaid spending a decade ago there was about 4 million New Yorkers on the program.

She then recalled that Frescatore said earlier in the hearing that number has since grown to 7 million.

“It doesn’t matter how many times we go back and look at the numbers and ask you for the data, you just can’t provide health insurance for 7 million people on a lowered cost from that which you started off on for 4 million people, and you shouldn’t be trying,” the chairwoman said.

Not only were lawmakers upset at the budget cut, but they were also upset that they received information detailing the cuts just the night before the hearing. State Sen. Tom O’Mara, R-Big Flats, said lawmakers had no time to review the plan.

For O’Mara, the ranking Finance Committee member who unsuccessfully tried to get Krueger to swear in Zucker at the beginning of his five-hour testimony, that maneuver is proof that the administration still is not being transparent with lawmakers even in the wake of the nursing home controversy.

“I find virtually everything you’ve said here today to be totally without credibility,” O’Mara told Zucker.


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Health advocates file lawsuit challenging Nebraska’s two-tier system for Medicaid expansion

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The Nebraska Medicaid expansion model includes a feature that provides additional benefits for members who meet wellness efforts and work requirements, and advocates filed a lawsuit to remove those requirements.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

LINCOLN — Health advocates filed a lawsuit Thursday targeting Nebraska’s two-tier system of Medicaid benefits for low-income, working-age adults.

The suit takes aim at what state officials called Heritage Health Adult, under which most Medicaid expansion patients get only a basic tier of benefits.

The state’s plan had been to require that those people meet wellness, personal responsibility and community engagement goals to qualify for dental, vision and over-the-counter medication benefits, which are part of traditional Medicaid coverage.

Nebraska Appleseed attorney Sarah Maresh called the system unlawful because it created “barriers and burdens” for enrollees, in violation of the Medicaid expansion law passed by voters in 2018.


“With coverage beginning last October, community members are ecstatic to finally be able to see a doctor without worrying about receiving a high bill they cannot afford,” she said. “However, we’ve also heard of the frustration and confusion caused by the unnecessary complexities of the tiered benefits system.

“This lawsuit seeks to fully implement the will of Nebraska voters and undo the unlawful actions of the (state Department of Health and Human Services),” Maresh said.

An HHS spokeswoman said the department does not comment on pending litigation.


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Georgia Senator Ben Watson says Biden Administration’s decision to review Medicaid waiver program leaves low-income Georgians in limbo



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GA Senator says Biden’s dismissal of their approved waiver to expand Medicaid coverage for those that work is unfair, and that the argument to suspend the work requirements due to COVID does not make sense for GA, where unemployment is low.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


The following is an excerpt from a recent “The Commute” podcast interview with Georgia State Sen. Ben Watson. “The Commute” is presented by the National Office Systems. Full episodes are available at or through mobile device podcast apps by searching “The Commute with @SavannahOpinion.”

Question: The Biden Administration has rescinded the approval for one of Georgia’s Medicaid waivers meant to provide health care coverage for the lowest-income Georgians. The feds are now reviewing that waiver. Is this a deal breaker? Or something where the details can be worked out?

Ben Watson: “That’s still to be determined. The state of Georgia applied for two waivers, and the one at issue now is the one that covered people from 100% of poverty level down to zero. The other waiver covered those from 100% of poverty level up to 138%. Both were approved last fall by the previous administration, and we were moving forward. What is fundamentally different about the waiver in question and those in every other state is we were proactive in requiring those on the waiver to do 80 hours of service a month. They could volunteer or work part-time or go to technical school or college, so long as they could account for 80 hours a month or 20 hours a week they would be eligible for Medicaid. That was what our thought process was. I still think it’s a good process.”

Question: That work requirement, or service hour requirement, seems to be the sticking point for the Biden Administration. What was your reaction when you heard approval had been pulled and the waiver was in review?

BW: “I was disappointed. We have 30 days to respond and we’ll continue to look at all avenues. From there, the new administration will make a determination. I just hope it is not political, because I think we have a good thing. The governor and his team and the Legislature worked together on this. I think it’s a good system and a good solution, and I think states should be allowed to determine what’s best for their own situations.”

Question: Critics will say the COVID-19 pandemic has made the work requirement untenable because either there aren’t enough jobs or there are people who are apprehensive about working or volunteering or going to school because of the virus. How legitimate is that argument?

BW: “That’s just an excuse. Georgia’s unemployment rate is one of the lowest in the nation right. We’re among the top-five economies in the nation. We’re recovering, and we’ve done better than expected. The cynic in me says, ‘Well, if I’m looking at this program and living in Washington, D.C. or New York City or someplace like that then that might be a realistic discussion.’ But that’s not the case here in Georgia. It doesn’t hold muster. As for the service hours requirement, if people cannot meet that, there are other safety nets for them, such as applying for disability.

“If you believe the government can do better with Medicaid than Georgia can do with these minimum requirements here, I will disagree with you on that one.”


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