Medicaid work requirements: Cost more and cover less

Ever since the federal Centers for Medicare and Medicaid Services (CMS) released its guidance on work requirements earlier this year, there has been a lot of buzz about Kentucky, which will be the first state to establish work requirements for its Medicaid expansion populations.

While there is plenty of uncertainty about the impacts that this change will bring, there is one thing we know for sure: Kentucky taxpayers are going to have to pay more to cover fewer people.

But, “how could that be?” you might be asking. How could it cost the state more to require people to work?

Here’s how: The reality is that work requirements are incredibly costly to administer, even as they create barriers to health care for many people.

Indeed, recent budget proposals out of Kentucky anticipate that it will require $180 million in new expenditures during each of the next two years to cover the administrative costs of updating technology and tracking compliance with the requirement through case workers. That’s money that will not go toward health care or helping people via other essential public services, but rather simply toward funding bureaucratic systems.

As North Carolina’s General Assembly considers closing the coverage gap via a program like Carolina Cares, members would do well to avoid heading down this same costly and bureaucratic road — especially since such programs frequently do a poor job of actually connecting people to jobs or skills training. Instead, they should remove the bureaucratic work requirement, which would likely be an even more costly endeavor here than in Kentucky given the nature of the current technology and administrative systems in North Carolina, not to mention the Medicaid overhaul that state leaders expect to implement in the next few years.

Finally, even if it were possible and cost-effective to establish a new Medicaid work requirements bureaucracy, it must also be pointed out that  North Carolina is extremely poorly positioned to implement work requirements in a way that guarantees employment and health care for those struggling in today’s economy. The reason: the jobs just aren’t there.

Eighty-seven of the state’s 100 counties have more jobless workers than job vacancies and the cost of job training is increasing and remains inaccessible for many. Such a cost has also not been contemplated in projections for North Carolina’s budget in future years — projections that already strongly suggest the state will not have sufficient revenues to meet current service needs.

The bottom-line question for proponents of Medicaid work requirements, therefore, is this: Why would our leaders push to serve fewer people with health care and force cuts to other programs and services that support family well-being and children’s educational success? Until someone comes up with a good answer, North Carolina should reject this bureaucratic and wasteful idea.