REFORM (OH)- Ohio to seek work requirement (again) for Medicaid enrollees

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[MM Curator Summary]: Let’s wait until Lord Biden is out, then ask again.



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A demonstrator walks through a crowd with a sign on her back during a protest calling for an expansion to Medicaid outside the State Capitol in Atlanta. on the first day of the legislative session, Monday, Jan. 13, 2014, in Atlanta. (AP Photo/David Goldman) AP


COLUMBUS, Ohio – Ohio will again ask the federal government in 2025 whether it can impose a work requirement on residents who get health insurance through Medicaid.

Language contained in the state budget, which Gov. Mike DeWine signed Tuesday, requires Ohio to apply to the federal government to impose the new rule. If granted, able-bodied Ohioans 55 and younger would need to either work or study for at least 20 hours per week (with exceptions for the mentally ill and some others) as a term of enrollment for Medicaid, a state and federally funded program that provides insurance for lower-income Americans.

This marks the state’s second attempt to impose Medicaid work requirements in the last decade. In 2017, state lawmakers included a Medicaid work requirement within the state budget. The federal Centers for Medicare and Medicaid Services under President Donald Trump approved Ohio’s request in 2019. However, the coronavirus pandemic blocked it from taking effect. President Joe Biden’s administration subsequently rejected the requirement.

An earlier version of the budget would have required Ohio to apply in November 2024. The final version, though, delayed it until February 2025 – after the conclusion of Biden’s first term and possibly under a different presidential administration.

The Biden Administration’s reversal letter in 2021 echoed reasoning shared by judges who blocked other states’ applications: the work requirements will lead to people losing health care coverage, when the point of Medicaid is to expand access to care to those who need it. The letter cited research estimating as many as 163,000 beneficiaries in Ohio would lose health insurance in the first year under the policy.

About 3.6 million Ohioans (30% of the state) receive health insurance through Medicaid, including about 1.3 million children. With some exceptions, Medicaid is available for those earning less than 138% of the federal poverty line. For a single person, that’s about $20,000 per year.

The status of work requirement policies has ping-ponged over the last decade. Alongside Ohio, the Trump administration approved 12 such waiver requests, according to KFF, a nonprofit that researches health policy. Those would have been the first work requirement policies in its nearly 60-year history.

Of the 13 states, Arkansas was the only one to implement its policy. In nine months of existence, the state with about one quarter the population of Ohio saw 18,000 residents knocked off their coverage. A study published in Health Affairs found the policy didn’t increase employment, forced recipients into medical debt, and caused enrollees to delay both care and medications due to cost.

The Washington D.C. Circuit Court of Appeals, the second-highest court in the U.S., later overturned CMS’ approval of Arkansas’ program, ruling that the decision to allow it deviated from the intent of the program when Congress enacted it – providing health care for the needy. The U.S. Supreme Court declined to take up the case, but other lower courts have issued similar rulings. Meanwhile, the state of Georgia just launched its own such policy, The Washington Post reports.

An Ohio Department of Medicaid spokeswoman said officials will begin to work with other employment-focused state agencies to “encourage self-sufficiency among enrollees.” She said she did not have any data immediately available regarding the employment rate of Medicaid enrollees.

“Governor DeWine and our administration are supportive of work efforts, believing an individual’s active engagement in their own economic wellbeing is consistent with the program and furthers its objectives,” said department spokeswoman Lisa Lawless. “Further, the U.S. Department of Health and Human Services “Healthy People 2030″ campaign also identifies job opportunities, education, and income as social determinants of health.”

A KFF survey of federal 2021 data found that about 60% of nonelderly Americans who don’t receive disability benefits were working. The top reasons for not working were caregiving responsibilities, illness, disability, or school. About 9% said they were retired, unable to find work, or gave another reason.

DeWine in 2021 directed Attorney General Dave Yost to appeal CMS’ rejection of Ohio’s Medicaid work requirements. When he announced the appeal in 2021, he said the policy was a reasonable approach that “provided individuals with options while supporting them on their way to self-sufficiency.”

At a press conference Wednesday, DeWine said little when asked about why he signed the provision.

“That’s not any change at all,” he said. “That’s consistent policy.”

Jake Zuckerman covers state politics and policy for and The Plain Dealer.


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