{"id":31070,"date":"2018-12-20T15:56:18","date_gmt":"2018-12-20T21:56:18","guid":{"rendered":"http:\/\/stateimpact.npr.org\/oklahoma\/?p=31070"},"modified":"2019-03-10T16:50:03","modified_gmt":"2019-03-10T21:50:03","slug":"oklahomas-medicaid-work-requirement-targets-poor-caregivers","status":"publish","type":"post","link":"https:\/\/stateimpact.npr.org\/oklahoma\/2018\/12\/20\/oklahomas-medicaid-work-requirement-targets-poor-caregivers\/","title":{"rendered":"Oklahoma\u2019s Medicaid work requirement targets poor caregivers"},"content":{"rendered":"
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Jackie Fortier \/ StateImpact Oklahoma<\/p>\n

Dan Straughan, executive director of the Homeless Alliance stands in their day shelter in Oklahoma City during lunch. If the Medicaid work requirements are approved, it will mean more administrative costs for non-profits like his, which connects homeless families to services.<\/p>\n<\/div>

This year the Trump Administration said it would support states imposing \u201ccommunity engagement\u201d requirements on Medicaid. That means, for the first time in the program\u2019s history, states can require people to work a certain number of hours to be eligible for the government health program for low-income Americans. <\/span><\/p>

Before they can issue work requirements, states have to <\/span>apply and be approved for waivers<\/span><\/a> from the Centers for Medicare and Medicaid Services.<\/span><\/p>

Last spring, Oklahoman Republican lawmakers rallied and quickly drafted a bill that sailed out of committee and handily passed both houses. <\/span><\/p>

Gov. Mary Fallin even issued an executive order, and in December 2018, Oklahoma became the 11th state to ask the federal government to sign off on Medicaid work requirements.<\/span><\/p>\n

Poor parents most affected<\/span><\/h3>

Unlike the five states approved so far, Oklahoma has not expanded Medicaid. The state already has some of the<\/span> strictest eligibility requirements<\/span><\/a> in the country. A family of three \u2014 two parents and one child \u2014 become ineligible if they earn more than $9,343 a year. The only non-elderly adults without disabilities on Medicaid in Oklahoma are poor parents or caregivers. <\/span><\/p>

\u201cA single mom with older kids is probably the typical person as I understand it, who would be impacted by this work requirement,\u201d said Rick Snyder, vice president of finance with the Oklahoma Hospital Association. \u201cIt may be a social philosophy of some that everybody ought to work and do their fair share, the reality is somewhat different than that.\u201d<\/span><\/p>

Although Oklahoma\u2019s work requirements include exemptions for those who are elderly, disabled or pregnant, among others, the new policy could put <\/span>thousands <\/span>of low-income adults<\/span><\/a> at risk of being dropped from Medicaid. Snyder said <\/span>uninsured people often end up in the <\/span>emergency room for routine care<\/span><\/a>, which hospitals are required by federal law to provide. That drives up health care costs for everyone, even people with insurance. <\/span><\/p>

\u201cFolks need care, and we provide care, and there\u2019s no payment for the care, that\u2019s a cost that ends up getting passed on to people who have group health insurance or individual health insurance and that results in high health care prices,\u201d Snyder said. \u201cRural Oklahoma hospitals are on average significantly in the red, losing money on operations and any loss of coverage is just going to make that worse.\u201d<\/span><\/p>\n

\"\"<\/p>\n

Jackie Fortier \/ StateImpact Oklahoma<\/p>\n

Rick Snyder, vice president of finance with the Oklahoma Hospital Association. He says work requirements will hurt rural hospitals.<\/p>\n<\/div>\n

Who is exempt?<\/span><\/h3>

States have set up different rules on how many hours a month Medicaid enrollees must work or volunteer \u2014 and who is exempt. <\/span><\/p>

In Oklahoma, non-disabled adults would be required to work, volunteer or go to school for 80 hours a month, or risk losing their government health insurance. <\/span><\/p>

People younger than 19 and older than 50 would be exempt, parents of children younger than 6, people in addiction treatment and those who can prove they have a disability. Medicaid recipients could also apply for a \u201cgood cause\u201d exemption, which the application states, \u201cwill be reviewed and determined on a case-by-case basis.\u201d Cues for a \u201cgood cause\u201d exemption will be taken from a <\/span>similar exemption in Oklahoma\u2019s<\/span><\/a> food stamp program, where, if a person falls under the required number of hours, but it wasn’t their fault and they still have their job they won\u2019t be disqualified from the program.<\/span><\/p>

Many Oklahomans on Medicaid who qualify for an exemption will have to refile annually with the state Health Care Authority. The agency will have to verify monthly if the hours reported by those working or volunteering qualify, and if they don\u2019t have enough or are the wrong type, take action.<\/span><\/p>

Some states, including Oklahoma, are asking for permission to exempt Native Americans from their proposed work requirements. But officials at the National Indian Health Board say that may be moot since federal officials can reject parts of the applications. <\/span><\/p>

The Trump administration contends the <\/span>tribes are a race rather than separate governments<\/span><\/a>, and exempting their members from Medicaid work rules constitutes illegal, preferential treatment. Tribes have threatened legal action if their members are included, but the issue remains unresolved. <\/span><\/p>

Native Americans have the highest uninsured rates nationally and in Oklahoma, and the state <\/span>ranks near the bottom<\/span><\/a> for children with health insurance coverage.<\/span><\/p>\n

How many Oklahomans will be affected?<\/span><\/h3>

Reporting <\/span>worked hours<\/span><\/a> has been a sticking point in <\/span>Arkansas<\/span><\/a>, the only state with active work requirements. To date, nearly <\/span>17,000 people in Arkansas have lost health coverage<\/span><\/a>, and many advocates blame a lack of communication with Medicaid members about the existence of the program, coupled with limited internet access. <\/span><\/p>

The Oklahoma Health Care Authority reached out to 400 people it determined may be impacted if the work requirements are approved, conducting a phone interview to ask about their access to reliable transportation and childcare. Just 18.5 percent responded. <\/span><\/p>

Arkansas has more people on Medicaid because it expanded the program under the Affordable Care Act; Oklahoma has not, and has fewer people in its Medicaid program. But nowhere in Oklahoma\u2019s application do officials estimate how many people will be affected if the work requirement is approved. StateImpact Oklahoma asked for more information, but Oklahoma Health Care Authority officials declined to elaborate.<\/span><\/p>

\u201cIt\u2019s deeply concerning to me that the Health Care Authority can\u2019t put a number on that in the application. It just flat says, we don\u2019t know how many people it will affect,\u201d said Dan Straughan, executive director of the <\/span>Homeless Alliance<\/span><\/a> in Oklahoma City. <\/span><\/p>

If the work requirements are approved, it will mean more administrative costs for nonprofits like his, which connects homeless families to services. <\/span><\/p>

\u201cThose organizations don\u2019t exist in rural Oklahoma. And rural Oklahoma has a higher poverty rate than urban Oklahoma,\u201d Straughan said. \u201cThe availability of those job opportunities, availability of volunteer opportunities, accessibility to public transportation to get to those jobs, is concerning to me.\u201d<\/span><\/p>

State Sen. Ron Sharp, R-Shawnee, voted for the work requirement legislation, after initially opposing it. <\/span><\/p>

\u201cWell I voted \u2018yes\u2019 on this bill because when you look up at the board, the last thing that you want to see is that you are one of the only Republican Senators who was voting no,\u201d he said. \u201cAll the Republicans voted \u2018yes.\u2019\u201d<\/span><\/p>

Sharp said he still has concerns about how single parents subject to the work requirement will pay for expensive childcare while they are completing their mandatory hours. But, he said, the state Legislature may rethink the policy when it reconvenes in February.<\/span><\/p>

\u201cThere\u2019s no doubt in my mind that the Legislature has shifted to a more centralistic ideology, so we\u2019ll have to see how these new legislators look upon all this,\u201d he said.<\/span><\/p>

Another new factor is the price tag: The Oklahoma Health Care Authority estimates the program will cost $1.7 million to create and run for the first year. The state will have to pay for about half of that \u2014 around $865,000, which the agency asked for in its upcoming budget.<\/span><\/p>\n

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