Health

A sign at dusk with one bright light next to it.

A Closer Look At Michigan’s New Medicaid Work Requirements

By Kathleen Schenck
Nov. 29, 2018

At a time when life expectancy in the United States has declined due to suicide and drug overdose, Governor Snyder signed Senate Bill 897 on June 22, 2018. The bill, sponsored by state Senator Mike Shirkey (R), is now Public Act 208 of 2018. It requires some Medicaid recipients to work for their health care, or risk losing coverage altogether.

The new Medicaid work requirements are slated to begin January 1, 2020. Governor-elect Gretchen Whitmer is opposed to the work requirements, but her options at this point are unknown given the bill is now statute.

Governor Snyder’s office explains the work requirements via email:

Under the adjusted requirements, beneficiaries will be required to have at least 80 hours per month at a part-time job, a postsecondary educational institution or high school equivalency test training, a job training program, volunteer work or community service, an internship, or substance abuse treatment. Those exempted from the requirements include anyone age 63 or older, disabled persons, pregnant women, full-time students, children, a parent of a dependent child younger than age 6, a recipient of unemployment benefits and anyone under age 21 who had previously been in foster care.

This explanation includes several false assumptions. One, that Medicaid recipients need more education, test training, or job training. Two, that they can afford more education, or test training, or job training. Three, that they are furthering their career goals by working for free as an intern or volunteer.

The emailed message included a link to an article on the work requirements titled “Q&A: How does SB 897 alter the Healthy Michigan Program?” with no author listed, though Governor Snyder is mentioned in third person, and a thumbnail picture of him along with his official government website address appear at the top of the page. The final point states, in devil’s advocate fashion, “In some states with work requirements for Medicaid, they have actually seen their costs go up. If the whole point is to save money, this bill doesn’t make any sense.” And the response given:

The state was required to re-apply for a Healthy Michigan waiver this year. While going through that process, the state is opting to add requirements for coverage that are more in line with the conditions for food and cash assistance. Lowered costs for taxpayers may be realized over time, but the ultimate aim of the bill was to ensure the standards of our program mirror those of similar programs and other states and make our waiver likely to be approved by the federal government so that the Healthy Michigan program can continue well into the future.

When the answer hedges that “lowered costs for taxpayers may be realized over time,” Michiganders deserve the fuller picture. The legislative analysis, or fiscal note, admits “there is not data with which to provide a more precise state fiscal impact.” Estimates range from 5 to 20 million in net savings per year, stemming from the projected number of Michiganders kicked off Medicaid. But the fact is we don’t know. The data simply isn’t there.

Where is the data on how well these work requirements are strengthening food stamp and cash assistance programs? And Michigan should be more like the handful of states experimenting with work requirements? More like Arkansas? They have neon snakes there. We don’t need to be more like Arkansas.

But it’s the last reason that is the most troubling: make our waiver likely to be approved by the federal government so that the Healthy Michigan program can continue well into the future. Translation: make Medicaid harder to get, harder to keep, thereby reducing the number of beneficiaries and purportedly pleasing the federal government enough to ensure the scaled-down version of the program will continue. It is a forgone conclusion that there will be no fighting on behalf of the well-being of Michiganders. The fact that the vote followed party lines (with one sole Republican joining all state Democrats in voting against it) speaks to the political motivations behind the bill.

Back to money. The fiscal note addresses the costs to the state for implementing such a program: “The other significant fiscal impact would be the added administrative casework and information technology updates required to verify hours worked, qualifying exemptions, and other casework each month for the approximately 670,000 Healthy Michigan Plan recipients. Other state fiscal estimates for added administrative costs have ranged from as low as $17.5 million to as high as $70.0 million.” That’s quite a range, and some hefty price tags. Where is the guarantee that kicking Michiganders off Medicaid will save our state money? It seems at best more like a hunch, or a “feeling.”

The bill, now Public Act, contains more problematic details, such as the need to “verify qualifiying work activities” by the tenth of each month to MiBridges. If you fail to do so, or if you fail to meet the requirements in the first place, you will lose health insurance. If you then meet the requirements in the future, you will still lose health insurance for the time you failed to meet the requirements plus an additional month as punishment.

Supporters of the work requirements will undoubtedly cry about those who “abuse the system.” Let’s take a look at a handy pie chart to view the Michiganders who stand to lose health care.

Pie chart lists only 3.2% as "the rest" of Medicaid recipients who the work requirements target.
Courtesy of healthinsurance.org.

6.9% are actively looking for work. Will they be exempt from the work requirements? 3.2% of recipients are, it could be argued, “taking advantage of the system.” If they’re not working and not in school, or church, or SAT prep, what could they possibly be doing? Driving new Altimas and eating whoopie pies?

The working poor will struggle even more under this new bill. What’s referred to as the “gig economy” is more accurately a “hustle economy.” Americans hustle to make ends meet. People who work a few months and then get laid off (whether or not the government deems it a layoff), such as farm workers, adjunct professors or freelancers, would stand to lose Medicaid under the new work requirements. Anyone who does not work a “typical” job is at risk of losing health care.

But all the factories and big-box stores and child care centers and schools offering low-paying jobs will have a bumper crop of involuntary employees. Remember who sponsored this bill: a senator with his own manufacturing company. From Ballotpedia: “His [Senator Mike Shirkey] professional experience includes working as the owner of Orbitform, an engineering company that manufactures forming, fastening, joining and assembly equipment.” Might he benefit from some $12/hour labor?

We are a country that prides itself on its Protestant work ethic. It is a closely-held belief that so very much can be solved by a good honest day’s work. But the work requirements for Medicaid do not provide work as much as take away health care. As Michigan Senate Minority Leader Jim Ananich (D, Flint) explains, if Michigan wanted to improve its employment situation, “we’d put money toward daycare, we’d put money toward transportation, we’d make sure the talent programs we’re talking about funding were already in place.” Instead, the state will be taking away people’s health care, and blaming it on the people.

No adult should have to defend not having a job. For those folks who think they should, there are already built-in feelings of shame that many unemployed face. Searching for a job is a full-time job, but not one that is valued by society because no one’s bringing home a paycheck. Threatening to retract health insurance says you are only worth taking care of if you work. And there are reasons for not having a job that don’t fit neatly into a government box.

We keep hearing how unemployment is so low, and there are so many jobs available people aren’t even showing up to interviews. The fact is there are very few good jobs available, as can be seen by a quick search for jobs in Holland on indeed dot com. Of 6,499 jobs within a 20 mile radius, 5,624 of those jobs earn below $20,000 a year, and 5,559 are entry-level. (12 out of 6,499 jobs are senior level.) On one hand, an individual would have to earn less than $16.67/hour for 20 hours a week to still qualify for Medicaid. So there are plenty of those jobs to choose from. On the other hand, would you like to be an Overnight Stocker at Sam’s Club? Part-time, $11.50 an hour, from 9:30 p.m. till 6 a.m.? Or would you work normal school hours, Monday-Friday, as a paraprofessional for $10.25/hour, 9 a.m. till 3 p.m., making it difficult to work a second or third job, which you would need in order to make ends meet? Or would you care to work on a local assembly line, where each Friday afternoon your supervisor still hasn’t told you if you have to be back on the line at 6 a.m. Saturday morning. If you complain and encourage your coworkers to stand up for themselves, you’re fired for trying to “petition,” which along with “union” is a dirty word in Ottawa County. And you don’t have to dig too deep to see that jobs with low wages are often found in the worst industries for sexual harassment. A simple internet search yields study after study faster than you can say Pull yourself up by your bootstraps.

So far here we’ve only discussed single individuals who do not have a second source of income. Families who qualify for Medicaid face myriad challenges with the new work regulations. Concerning the exemption for caring for a child under the age of 6, Democrats fought for the bill to allow a higher age than 6, and lost. This raises new questions for the Holland parent who home schools. Will that parent’s teaching qualify as work? Community service?

Work requirements and the monthly verification involved to provide proof that those requirements are being met would only turn more Michiganders away from the health care they need. This is counterproductive to the entire purpose of Medicaid. As reported by The New York Times, a Kentucky judge argued, “Limiting access to medical assistance does not promote the objectives of the Medicaid program.” Michigan is messing with a successful social program that has been around since the 60s, when President Johnson signed the bill.

Recipients of Medicaid already have an uphill battle when it comes to accessing care. Many health professionals do not accept Medicaid. The justification often given is Medicaid pays the doctor’s office less and results in more paperwork. Ask your doctor if she/he accepts Medicaid. Ask your dentist.

Finally, the timing could not be worse. The Director of the Centers for Disease Control and Prevention, Dr. Robert R. Redfield, explains:

The latest CDC data show that the U.S. life expectancy has declined over the past few years. Tragically, this troubling trend is largely driven by deaths from drug overdose and suicide. Life expectancy gives us a snapshot of the Nation’s overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable. CDC is committed to putting science into action to protect U.S. health, but we must all work together to reverse this trend and help ensure that all Americans live longer and healthier lives.

The bottom line is this: If you are low-income and need health insurance, do not be deterred. Apply and apply again. If you know of someone who needs help applying, help them apply. If Ottawa County DHS tries to deny or cancel you for reasons I’ve heard such as the ink used on the form was “too light” or because you started a part-time, temporary job that were it a permanent position would pay over the eligible salary of roughly $16,000 a year, do not give up. Do not give up due to these and more bureaucratic reasons for cancellation, which are really ways and means of intimidation. As is the Medicaid work requirement.

If you receive Medicaid and have a caseworker, email her or him instead of trying to call or walk in. You will then have a record of your communication. This is a good thing. Usually you can find your caseworker’s email address by adding “@michigan.gov” after your caseworker’s ID, as explained here at Health Care Counts.

Next, use your Medicaid. Find a primary care physician you can talk to. Build that relationship. Tell her/him every single thing about yourself, from feelings of sadness or hopelessness to that odd pain in your wrist. If you are using drugs or cigarettes or alcohol, say so. Ask for help, ask for guidance, ask for clarification.

To apply for Medicaid, go to this page  on michigan.gov and either click “Use MI Bridges to apply for assistance, check your eligibility status and manage your account” or click on the link to download and print form DCH-1426: “download the printable PDF version of the DCH-1426, Application for Health Coverage & Help Paying Costs.”

Do not be deterred.

Holland Weekly welcomes your letters to the editor: hollandweekly@gmail.com.


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