Updated 6/25, 2:06 p.m.
The first study of Arkansas’ first-in-the-nation Medicaid work requirements was released this week, and it shows that they’ve kicked people off the program — but failed to increase, as its proponents claimed, the number of people working.
The study’s authors reported in the New England Journal of Medicine “significant losses in health insurance coverage in the policy’s initial six months but no significant change in employment,” and found that “thousands of individuals lost coverage, even though more than 95% of the target population appeared to meet the requirements or qualify for an exemption.”
The findings come just three months after a federal judge declared Arkansas’ work requirements unconstitutional and ordered them to be stopped immediately.
Starting next year, Michigan Medicaid recipients under the Healthy Michigan program will be subject to similar work requirements as the result of a 2018 law signed by former Gov. Rick Snyder.
Gilda Jacobs, president and CEO of the nonprofit Michigan League for Public Policy, said the new report confirms what Michigan policy analysts have long expected.
“This just reinforces the concerns that we have that this Medicaid work requirement does not increase employment, or do any of the other things its proponents say it’s going to do,” Jacobs said.
“… It’s really important for policymakers to look at other states that have enacted these [work requirements] to see what’s actually happening on the ground. … When we have the luxury of being able to look at what happened in other states, we need to use that data to help inform our decisions here.”
Under Michigan’s requirements, approved through a federal waiver last December, “able-bodied adults” between the ages of 19 and 62 who receive Healthy Michigan benefits will be required to provide proof that they’re working at least 80 hours per month in order to stay insured under the program.
The Healthy Michigan program, signed into law by Snyder in 2013, offers Medicaid services to people in the state with an annual income of up to 133% of the federally designated poverty line.
Earlier in June, the Michigan Senate passed bipartisan legislation that would ease the new work requirements, citing concerns similar to those raised in Arkansas and other states where similar measures have been passed. Bills from state Sen. Curtis Hertel (D-East Lansing) and Senate Majority Leader Mike Shirkey (R-Clarklake) will make the new law’s deadlines more flexible and provide certain reporting exemptions.
Some experts told the Advance at the time that it still might not be enough to prevent some from losing their enrollment unnecessarily, as they have in Arkansas. MLPP analyst Rachel Richards said earlier this month that the bills were a “good first step in mitigating some of the harm, but this is just a bad law.”
Republicans have described the law’s impact as relatively minor, with Snyder’s office saying at the time of last year’s waiver approval that it simply “created community engagement requirements that closely mirror current cash and food assistance program work requirements.”
The Arkansas study focused on Medicaid recipients between the ages of 30 and 49 who are most likely to be affected by the work requirements. Until March, the state required them to provide proof that they had worked 80 hours per month, the same amount required under Michigan’s new law.
It found that the number of people in that category who had either Medicaid or Affordable Care Act coverage (included due to a quirk in the state’s Medicaid expansion program) decreased by almost 7% from 2016 to 2018, spanning the period before and after the requirements’ implementation. The study also found the uninsured rate during the same period for that group increased by more than 10%.
Manatt Health, a health care-focused legal and consulting firm,* released a study in February that predicted 9% to 27% of the people who currently receive Healthy Michigan benefits could be kicked off the program’s rolls under the new work requirements.
That report, which was based on a comparison with Arkansas, said it considered in its prediction “the fact that Michigan will have more avenues for self-reporting of compliance and exemptions than were available during first six months of Arkansas implementation, when the main option was an online portal with restricted hours of operation.”
The federal Medicaid and CHIP Payment and Access Commission (MACPAC) echoed that concern in November 2018, urging the federal Department of Health and Human Services (DHHS) to stop Arkansas’ work requirements due to concerns that some Medicaid recipients without access to the internet may have been unable to report.
Under Michigan’s new law, Healthy Michigan participants are supposed to report their hours through the state’s online MiBridges system. Shirkey’s bill this month, however, included language that could allow them to report by other means.
Gov. Gretchen Whitmer has publicly opposed the work requirements, telling the federal government in a February letter that the “onerous reporting requirements could take away health insurance from people struggling to make ends meet, while accomplishing little to expand employment.”
Law professor and former state Supreme Court candidate Sam Bagenstos wrote an op-ed for Bridge in May in which he made the case that Whitmer has the legal authority to exempt around 70,000 people from the work requirements in particular “economically distressed” counties. Some estimates say that more than 500,000 people could be affected by them under the law as currently written.
Health insurance analyst Charles Gaba weighed in on the efforts to mitigate the requirements’ effect in an email to the Advance, saying “it doesn’t really matter how ‘easy’ you make the compliance rules or process … all the work requirements do is make it more difficult for people to receive healthcare services, which in turn makes it more difficult for them to get a job anyway.”
Robert Gordon, the head of Michigan’s Department of Health and Human Services (MDHHS), said in February that although he opposed the Medicaid work requirements, he would go forward with implementing them under the law.
Gordon told the Advance earlier this year that “the work requirements emerge from a goal that everyone shares, which is to foster independence for people when we can … but they do create tremendous risk that people will lose health insurance.”
In a statement to the Advance, MDHHS spokesperson Bob Wheaton said “MDHHS is very aware of the challenges faced by Arkansas and has spent significant time reviewing the early data that the Arkansas Department of Human Services has made available. The administration continues to have concerns about the work requirements, but we are fully committed to following the law and implementing on Jan. 1, 2020, as required by state statute.”
“MDHHS is also committed to providing early and robust communication, beneficiary education and advocacy involvement to help assure that Healthy Michigan Plan members do not lose coverage because of lack of understanding about the systems or process,” Wheaton said.
This story was updated to more accurately describe Manatt Health.