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Rauner administration looking at Medicaid work requirements

Friday, Jan 12, 2018

* Tribune

Illinois is reviewing new guidance from the Trump administration that opens the door for states to impose work requirements on Medicaid recipients, but there is no indication yet that it will follow the lead of neighboring states that are pursuing plans to tighten their rules.

Gov. Bruce Rauner’s office and the state’s Department of Healthcare and Family Services said the new policy and its implications are “under review,” but the Republican administration has not signaled whether it supports Medicaid work requirements. Local patient advocates said they hope Illinois does not join the 10 states that already have submitted proposals to make having a job a condition of Medicaid eligibility, for fear it would leave tens of thousands of people without health insurance. […]

More than 1.2 million non-disabled working-age adults receive Medicaid in Illinois, and most do work. Two-thirds of Illinois’ non-disabled and non-elderly Medicaid recipients hold a full-time or part-time job, and more than 80 percent are part of working families, according to the Kaiser Family Foundation’s analysis of 2016 Census data. Many others are caregivers or go to school. […]

Work requirements also are opposed by the Illinois Health and Hospital Association, which advocates for more than 200 hospitals and nearly 50 health systems in the state. The group believes work requirements would limit access to care and leave hospitals picking up the tab for uninsured patients.

Thoughts on this?

* Related…

* Another Illinois Medicaid shake-up threatens hospitals: For years, nearly every Illinois hospital has paid into a pot of money that helps the state bring in more federal dollars. But the program, effectively a tax on hospitals, is dated and doesn’t reflect how much the health care industry has changed… The reality is that a lot has changed. Low-income Chicago neighborhoods that surround safety-net hospitals have emptied out, dwindling their patient base. The push toward outpatient care means fewer people need to be hospitalized. At the same time, the state expanded Medicaid under the Affordable Care Act, leading to crops of new patients who sought care elsewhere. The bottom line: The current assessment program doesn’t reflect where Medicaid patients seek treatment. “It’s a tough process to renegotiate,” said Rep. Greg Harris, a Chicago Democrat who is among the state lawmakers working to redesign the program. “Every hospital in the state is affected. There will be winners and there will be losers.”

- Posted by Rich Miller        

  1. - Montrose - Friday, Jan 12, 18 @ 12:27 pm:

    I don’t believe in work requirements as part of accessing public benefits. I believe in providing real, substantive supports to folks that can use them to stabilize their lives and put them on the path to living wage work.

    Aside from that, Medicaid is much worse candidate for requirements than TANF or SNAP.

    - We are talking about public health issues and ultimately saving the state and the healthcare system money because people have access to regular care and preventive medicine.
    - We are also talking about a support that can’t be transferred to others - legally or illegally.
    - You know what makes it hard to get a job? Chronic health issues. It very literally about making sure people don’t die.
    - If you want people to take advantage of opportunity and be able to contribute to society, do not create a situation where they will be saddled with medical debt.

    Creating a work requirement just creates costly bureaucracy and undermines our collective public health needs. I hope common sense prevails.

  2. - Oswego Willy - Friday, Jan 12, 18 @ 12:32 pm:

    To appease that Trump base and get support from “Trump conservatives”, Rauner should come out in favor of this…

    … in a blue state Clinton won by 17 points, and he (Rauner) is sitting 25 points under water.


    Rauner should look at this.

  3. - Andrea Durbin - Friday, Jan 12, 18 @ 1:01 pm:

    There is no evidence that imposing Medicaid work requirements achieves the policy outcomes. It would increase administrative expenses dramatically, as we would have to monitor the employment status of all adults on Medicaid. It would cause people to lose health insurance, which actually hurts their ability to work.

  4. - 47th Ward - Friday, Jan 12, 18 @ 1:01 pm:

    Most Medicaid recipients in Illinois are children. It’s about time those deadbeats got off their behinds and found a job. Put down the X-Box and pick up a shovel, I say, or no health care for you.

    Also, drug test. Test them all for drugs, especially the children.

  5. - Sir Reel - Friday, Jan 12, 18 @ 1:03 pm:

    How about requiring work requirements on Governors who claim they’re not in charge?

  6. - NeverPoliticallyCorrect - Friday, Jan 12, 18 @ 1:05 pm:

    The is nothing inherently wrong with requiring someone who receives any unearned public entitlement to perform some type of public service or work. It is in he implementation where the trouble begins. Can they adequately and accurately determine who is capable of work, how do you verify that they have engaged in an active job search, have they been offered a job, how long do they need to keep a job to maintain eligibility? these and more details must be answered but who will do this? State government? Doubtful, they can barely keep the ship afloat now in Springfield without adding another layer of employees. And what will the oversight cost to Medicaid be in verifying work activities? Rauner won’t know how to do this and the Dems won’t want to add this level of accountability. Outcome in Illinois, it’s DOA.

  7. - illinifan - Friday, Jan 12, 18 @ 1:10 pm:

    The amount of man hours needed to track this activity would be cost prohibitive and the benefit questionable. Many persons on Medicaid already work (I have seen numbers ranging from 60-80% based on the population) and of those that don’t work often have disabilities that prevent employment. KFF reports that about 10% of Medicaid recipients fall into the able bodied group. Don’t think the policy would be of any major benefit.

  8. - Anon221 - Friday, Jan 12, 18 @ 1:13 pm:

    No surprise here… Kentucky just got approved-

  9. - Pelonski - Friday, Jan 12, 18 @ 1:35 pm:

    Some of the people who need Medicaid have very limited skills and education and find it difficult to get hired. Unless we are willing to guarantee that jobs are available to them, adding a work requirement should be a non-starter.

  10. - Not-so-lucky Pete - Friday, Jan 12, 18 @ 1:36 pm:

    2/3 of Medicaid benefits in Illinois go to senior citizens and people with disabilities.

  11. - yinn - Friday, Jan 12, 18 @ 1:42 pm:

    ==KFF reports that about 10% of Medicaid recipients fall into the able bodied group.==

    Yes, and many of the so-called able-bodied are actually disabled, but unable to qualify for benefits (or are caught somewhere within an often years-long process). Then there are able-bodied who are unpaid though full time caregivers to family members.

    What a potentially ugly development.

  12. - walker - Friday, Jan 12, 18 @ 2:07 pm:

    “”2/3 of Medicaid benefits in Illinois go to senior citizens and people with disabilities.”"

    Add in the children covered by Medicaid and the total number is around 85%.

    Doesn’t anyone who proposes such an idea bother to do any research?

    More an ideological stance than a practical one.

  13. - kimocat - Friday, Jan 12, 18 @ 2:33 pm:

    “Doesn’t anyone who proposes such as idea bother to do any research?” No, they don’t. Because it is not about what works, it is about what about appealing to the folks who think all poor people are lazy takers who deserve more grief in their lives.

  14. - Anonymous - Friday, Jan 12, 18 @ 2:49 pm:

    The general commentary here is right on the money. It’s a costly, impractical, and unworkable. And stupid.

  15. - wordslinger - Friday, Jan 12, 18 @ 3:09 pm:

    –“”2/3 of Medicaid benefits in Illinois go to senior citizens and people with disabilities.””

    Add in the children covered by Medicaid and the total number is around 85%.

    Doesn’t anyone who proposes such an idea bother to do any research?–

    Yes. Research shows it’s mighty fine red meat for the full-mooners.

  16. - Truthteller - Friday, Jan 12, 18 @ 3:39 pm:

    How about all the employers, like McDonalds and Wal-Mart, who don’t provide health insurance to their employees? The state would save a lot more money if it required these employers to pay Medicaid for their employees insurance then if it tries to impose a work requirement on the few people who might be able to work

  17. - Honeybear - Friday, Jan 12, 18 @ 3:47 pm:

    Just a technical question.
    How are you going to do this with the smallest amount of HSC’s, Human Services Caseworkers the state has ever had to perform the titanic task of administering this?

    Oh, oh that’s right

    We all know how much that has cost us
    And how well it worked.

    That’s the play afoot

  18. - Anon221 - Friday, Jan 12, 18 @ 3:55 pm:

    People who construct these policies like Seema Verma are hoping the policies will eventually make those people who, in their considered opinions, are a drain on society, just go away- one way or another. The patient dumping in Baltimore this week illustrates in heartbreaking detail how some people decide others should be treated.

  19. - RNUG - Friday, Jan 12, 18 @ 4:30 pm:

    == How about all the employers, like McDonalds and Wal-Mart, who don’t provide health insurance to their employees? The state would save a lot more money if it required these employers to pay Medicaid for their employees insurance then if it tries to impose a work requirement on the few people who might be able to work ==

    This … all day long. But it will not happen because we are addicted to cheap stuff …

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