Skip Navigation
Back to PolicyBot

The Leaflet: Will Federal Ruling Halt Medicaid Reform?

April 5, 2019

Utah's Medicaid work requirement waiver has been approved by CMS. Childless, able-bodied adults in the state must now meet certain conditions to obtain state health coverage through Medicaid.

Utah is the ninth state to receive approval for its Medicaid work requirement waiver. On March 29, Centers for Medicare and Medicaid Services Administrator Seema Verma approved Utah’s Section 1115 demonstration waiver, which would require childless, able-bodied adults to meet certain conditions to obtain state health coverage through Medicaid.

Although not as stringent as other approved work requirement waivers, Utah’s Section 1115 waiver would only require beneficiaries to search for jobs or participate in a training program within the first three months of a benefit year.

The waiver is unusual in two ways: (1) it would cap Medicaid enrollment for the expansion population if the state lacks funds, and (2) it would only partially expand Medicaid to adults with household incomes up to 100 percent of the federal poverty level, not the 138 percent level permitted under the Affordable Care Act. The limited expansion is estimated to cover 90,000 Utahans, 60,000 less than the 150,000 coverage estimate for the ballot initiative voters approved in November 2018.

Verma’s approval came two days after U.S. District Court Judge James Boasberg struck down work requirements in the Medicaid programs of Arkansas and Kentucky. The Trump administration contends work or community engagement as a condition of Medicaid eligibility promotes healthy behaviors, health care accountability, and financial independence in beneficiaries. Boasberg argued the decline in Medicaid enrollment due to work requirements is antithetical to the program’s core objective to provide medical assistance to needy populations, as outlined in the Social Security Amendments of 1965.

In 2018, Arkansas implemented reforms for able-bodied adults without dependents (ABAWDs) to either work, volunteer, or train for at least 80 hours per month. Since then, about 18,000 Arkansas residents have been removed from Medicaid rolls because they failed to meet the requirement.

A similar waiver in Kentucky has yet to go into effect because it has been blocked by federal lawsuits. However, Kentucky state officials estimate that 95,000 people would not be eligible for coverage if the waiver is implemented.

In 2013, Arkansas and Kentucky fully expanded their Medicaid programs to include ABAWDs. More than 420,000 Kentuckians enrolled in the expanded program. The new enrollees exceeded state projections by a whopping 134 percent and will cost Kentucky taxpayers an estimated $1.2 billion from 2017 through 2021. Nearly 300,000 residents are covered under Arkansas’ expansion, which will cost an estimated $1.9 billion by 2021.

Experts believe Utah’s letter of approval indicates the Trump administration will appeal the federal court decision. The ruling might threaten the future of Medicaid work requirements already approved in Arizona, Indiana, Michigan, New Hampshire, Ohio, and Wisconsin.

In “Don’t Wait for Congress to Fix Health Care,” Heartland Senior Policy Analyst Matthew Glans documents the failures of Medicaid and recommends innovative solutions states can adopt to reform the program, such as passing price transparency laws, creating high-risk pools, expanding health savings accounts, integrating direct primary care programs, and encouraging telemedicine.

 

What We’re Working On

Budget & Tax
Despite Scientific Evidence, More Americans Believe E-Cigarettes Are as Harmful as Tobacco Cigarettes
In this Research & Commentary, State Government Relations Manager Lindsey Stroud examines a new study that found the proportion of adults perceiving e-cigarettes as harmful as cigarettes jumped from 11.5 percent to 36.4 percent and from 46.4 to 55.6 percent in two separate surveys, respectively. “Unfortunately, actions by state lawmakers have fueled misperceptions on the efficacy of e-cigarettes and vaping devices. In 2019, several states introduced bills to regulate, tax, and even prohibit electronic cigarettes. States have brought forth Tobacco 21 and Vaping 21 proposals, which would severely restrict access to cigarettes and THR devices. Other legislation would regulate e-cigarettes as tobacco products,” wrote Stroud.

Health Care
Now Is the Time for States to Pursue Medicaid Reform
In this Research & Commentary, Senior Policy Analyst Matthew Glans argues state legislators should take advantage of the Medicaid waiver process and move to reform their Medicaid programs. “Under the Trump administration, CMS has been more than willing to give states the flexibility they need to improve Medicaid. State policymakers should take advantage of this important opportunity, rather than wait for Congress to solve their problems,” wrote Glans.

Energy & Environment
Boulder Mafia Ignores the Will of Colorado’s Voters (Guest: Amy Oliver Cooke)
In this episode of the Heartland Daily Podcast, Senior Fellow Sterling Burnett is joined by Amy Oliver Cooke, executive vice president and director of the Energy and Environmental Policy Center for the Independence Institute, to discuss how Colorado’s Democrats are pushing legislation in the middle of the night that would impose greater restrictions on energy development than the ones voters handily rejected via ballot initiative in 2018. That ballot initiative, proposed by out of state interests, would have prevented virtually all new oil and gas development throughout the state.

Education
Hope Scholarships Allow All Kansas Students Access to Safe Schools
In this Research & Commentary, Policy Analyst Tim Benson writes about a bill in the Kansas House of Representatives that would establish Hope Scholarships, a type of child safety account that empowers parents to remove their children from unsafe schools and place them in safer education environments. If legislators enact Hope Scholarships, Kansas children who have been bullied in school and reported a bullying incident to a teacher, counselor, or administrator would be eligible for the program. Parents could use funding from the Hope Scholarship to pay for tuition at a participating private school of their choice or at another public school.

From Our Free-Market Friends
Wisconsin Tax Options: A Guide to Fair, Simple, Pro-Growth Reform
The Badger Institute, in conjunction with the Tax Foundation, recently released a comprehensive overview of Wisconsin’s tax landscape. The report’s authors surveyed more than 100 stakeholders in the state, including small business owners, state legislators, industry representatives, and residents. The report outlines the state’s tax history and economic trends and explores “workable solutions” to provide fiscal relief to taxpayers that would make Wisconsin more competitive. Solutions include instituting a flat income tax rate, broadening the sales tax, and eliminating the corporate income tax.


Click here to subscribe to The Leaflet, the weekly government relations e-newsletter.

Author
Arianna Wilkerson worked in government relations at The Heartland Institute from 2017 - 2019.