Study: Coverage could decline with Medicaid work requirement

February 14, 2019 GMT

A new analysis released Wednesday estimates 26,000 to 36,000 low-income Montanans could lose health coverage if state lawmakers decide to pass a bill that would require Medicaid enrollees ages 19 to 59 to work 80 hours per month in order to receive benefits.

The report, compiled independently by researchers at the Milken Institute School of Public Health at George Washington University, comes as the Legislature ponders how to continue Montana’s Medicaid expansion program that is scheduled to sunset this year unless a plan is agreed upon.

The program, which passed in 2015, provides benefits to nearly 100,000 Montanans.

The analysis, which is based on a Feb. 5 draft of the Medicaid Reform and Integrity Act, says call-for-work requirements, otherwise known as “community engagement,” would also lead to a spike in premiums for current enrollees.

The bill would raise the monthly premium recipients must pay in order to gain coverage - a price many low-income residents already are struggling to meet.

Overall, the report estimates 9 percent, or an additional 5,000 to 7,000 enrollees, may lose their coverage due to increase in costs.

“If enacted, we estimate this bill would cause a total of between 31,000 and 43,000 low-income Montanans to lose their Medicaid coverage,” said Leighton Ku, lead author of the report. “Many people likely to lose coverage are already working when they can or they live in rural areas and are unable to find a job.”

Enrollees aren’t the only ones expected to feel the effects of the bill, should lawmakers choose to pass it.

The report states “hospitals, community health centers and similar facilities, particularly those in rural areas, will lose Medicaid revenue and have to care for more uninsured patients. This will destabilize them financially, increasing the risks of service cutbacks or closures.”

The report also highlights the state’s voluntary work promotion system for those on Medicaid that has “provided training and has aided in increasing employment.” The report says the program, HELP-link, has been “viewed as a national leader.”

Neither Democrat nor Republican lawmakers support ending Montana’s Medicaid expansion program.

Democrats have pushed to keep the current bill in place, one that would cost Montana an estimated $60 million per year by 2020. However, the cost to continue the current plan would account for about 9 percent of the total federal dollars the program would bring to the state.

In a press release Wednesday, Democratic Gov. Steve Bullock used findings from the study to back his interest in continuing the state’s current program.

“We already have a successful bipartisan approach to Medicaid expansion that ensures healthy people are finding and keeping good jobs. It doesn’t make sense to me that we would abandon this approach all to spend more money, kick up to 43,000 Montanans off of their coverage, and hurt our rural hospitals.”

On the other hand, Republicans have pushed for work requirements for months, maintaining the program has been “misused.”

In October, 67 Republican lawmakers signed a letter asking the governor to work toward enacting the work requirement by applying for a federal waiver. The letter requested that able-bodied adults, with some exceptions such as pregnant women, be required to work in order to receive benefits.

Reporter Kianna Gardner can be reached at 758-4439 or kgardner@dailyinterlake.com