Advocates are worried about the process that will eventually require thousands of Ohioans in Medicaid expansion to work 20 hours a week or lose their benefits, which the state got permission to impose earlier this year.
The advocates for Medicaid expansion still have big concerns about how this will work and how many people will be kicked out of the program.
Last week, Ohio Medicaid sent out a letter detailing how the state will implement those work requirements. But director Maureen Corcoran said no one's just going to get a letter saying they’ve lost their healthcare through Medicaid expansion.
"We are going to have a warm handoff, a contact with people. We’re not going to just kick people off. And it also is why it’s taking a little bit of time to get the program ready," Corcoran said.
Corcoran said two-thirds of the 600,000 people in Medicaid expansion will be exempt from work requirements.
This group includes recepients that are caring for a young child or other family member, they have a chronic illness, they're in school or drug or alcohol treatment or they’re already working more than 20 hours a week but still earn less than 138% of the federal poverty level, which this year is around $17,000 for a single person.
As local officials reach out to the remaining third who records show don’t have a qualifying exemption, Corcoran said she expects to find another 20-25% who will be exempt.
"We're looking then at a small group of roughly 5-10% of individuals who really then fall into the group where the local job and family services will meet with them, will talk with them about the need to either go back to school, help them work on getting a job, go through what their options are," Corcoran said.
That could mean as many as 60,000 Ohioans would need to find work or lose their benefits – with the state’s unemployment rate at an 18-year low. Earlier this year, the state had estimated as many as 109,000 could be kicked off.
Cleveland's Center for Community Solutions has supported Medicaid expansion.
A resercher at the center, Loren Anthes, noted that Gov. Mike DeWine had said during his campaign last year that work requirements as ordered by state lawmakers in 2017 were necessary to make Medicaid expansion sustainable, athough he had said when he was still running for the Republican nomination for governor that Medicaid expansion was unsustainable.
Anthes said the state will have to spend money on case managers and IT experts to track people in the program.
"We're paying $5 million a year to research this project and even in the context of the evaluation design – the language that the state put forward says, we're not even sure that this is going to be meaningful because of the issue of churn," Anthus said.
That "churn" is people leaving Medicaid expansion, which Anthes said happens most often because they get better paying jobs because they're healthier. After peaking in 2017, the Medicaid expansion population has been dropping – it’s down almost 40,000 people in the last year.
Anthes said there's evidence that Medicaid expansion has saved tens of thousands of lives by providing opioid treatment, helping with maternal mortality and improving health care access in rural areas – along with cutting eviction rates and lowering debt.
"With all those other benefits, and with the fact that it's a relatively small investment directly by the state, I don’t know what work requirements really do other than it’s policy that's really disguising politics," Anthes said.
Anthes views work requirements as a way to restrict eligibility and therefore lower costs. But he said the DeWine administration deserves credit for a "thoughtful" program that he says is not as punitive as those in other states. Medicaid director Maureen Corcoran said it’s not meant as punishment, but as a way to humanely emphasize the importance of work.
However Corcoran said it will give information about the real needs and costs for people in Medicaid expansion, which could lead to savings. For instance, she said the state has found people in the program have some serious medical and behavioral health issues.
"They're a relatively 'inexpensive' – and I put that word in quotes – a relatively inexpensive group as a whole so it doesn't cost as much, for example, as someone who has a disability. But that doesn't mean that it doesn't add up and that there are concerns about the budget," Corcoran said.
It's estimated Medicaid expansion will cost the state nearly $5.2 billion in 2021, the first year Ohio will pay its full 10% share of costs as determined by the Affordable Care Act. Corcoran said Ohio's work requirements program is set to launch in January 2021.
Work requirements waivers have been approved in nine states, and are pending in nine more. However judges have set them aside in Arkansas, Kentucky and New Hampshire, and Indiana suspended its program because of ongoing legal challenges.
It’s also thought that recent election wins by Democrats in Virginia and in the Kentucky governor's race might shut down implementation of work requirements in those states.