Analysis: 26,000 to 36,000 would lose Medicaid expansion coverage with work requirements
An independent analysis estimates about 26,000 to 36,000 low-income adults would lose coverage under Medicaid expansion in Montana if proposed work requirements are put in place.
That’s according to a report on the potential effects of work requirements from George Washington University’s Center for Health Policy Research at the Milken Institute School of Public Health in Washington, D.C.
The analysis, released Wednesday, is based on the draft of Republican Rep. Ed Buttrey’s bill from Feb. 5 and written by Leighton Ku and Erin Brantley.
Montana first passed Medicaid expansion in 2015 with a bill carried by Buttrey called the Montana Health and Economic Livelihood Partnership (HELP) Act. About 95,000 people are covered under the program, which is set to expire at the end of this year unless lawmakers continue it.
Buttrey’s bill this session, called the Medicaid Reform and Integrity Act (MeRIA), includes what is called a “community engagement” provision.
That is an 80-hour monthly requirement that can be met with activities like work, or for those who can’t work, volunteering, seeking a job, substance use disorder treatment or other things.
The requirements are similar to what the state of Arkansas enacted for its Medicaid expansion program last June.
The assumptions the university’s analysis made about a work requirements in Montana were based on Arkansas’ experience, as well as the work requirements for the Supplemental Nutrition Assistance Program, the food stamp replacement program known as SNAP.
After Arkansas implemented work requirements in June last year, about 18,000 had lost coverage by December. About 252,642 people were covered, meaning about 7 percent lost coverage in the first six months.
Buttrey has said his bill isn’t modeled on Arkansas’ version. It has a similar hours requirement, however. Buttrey also cautioned that his draft is subject to change before it’s finalized. It has yet to be introduced.
Buttrey said earlier this month the hour requirement is still being fine-tuned, along with the exemptions.
“We certainly don’t want to put an hour requirement that is punitive,” Buttrey said then. “I’m not trying to do something that’s going to cause enrollment numbers to drastically change.”
The analysis estimates the requirement proposed in Montana would cause about a third of those covered under expansion to lose coverage. Another third are expected to qualify for an exemption from the requirement and a final third are projected to meet the work requirement.
The analysis found several barriers to meeting work requirements.
More than a third of of people covered under expansion have seasonal employment and already work six months or more each year, but not enough to meet the requirements for a full 12 months, for example. If people don’t work 20 hours a week for three or more months, they would lose coverage.
The authors also found other challenges. About a third of people covered under expansion live in rural Montana, which could mean fewer job opportunities. About 20 percent of people covered lack internet access, which would reduce their ability to report work hours or exemptions.
Additional paperwork and administrative barriers could also cause people to lose coverage because even if they work enough hours, they would not be adequately informed about the policies, would not understand notifications from the Medicaid program and are not literate or have mental health problems, the analysis found.
The draft bill also includes increased premiums for people enrolled in the program more than two years, with a cap at 5 percent of income. That’s something else the analysis says could lead to an additional 9 percent drop in coverage, or about 5,000 to 7,000 people.
Hospitals could also feel a crunch under the bill, the analysis found. That would come from a loss of revenue from patients who were covered by Medicaid expansion and an increase in patients coming in without insurance. Montana hospitals reported their uncompensated care load of about $400 million dropped by half after expansion.
The analysis says Montana’s draft bill is “more severe” than Arkansas’ or SNAP because its exemptions are more limited. For example, the draft exempts full-time caregivers to children ages 6 and under, while Arkansas exempts all parents and others living in a household with a minor child.
The Montana bill would also extend requirements to people ages 50-59, while Arkansas and SNAP exempt that population.