Kathleen Gray | Detroit Free Press

LANSING – A bill requiring many Medicaid recipients to work at least 80 hours a month is headed to Gov. Rick Snyder after the Senate gave final passage to the bill Thursday.

And Snyder said he's ready to sign the bill.

“Healthy Michigan has been integral to improving the health of Michiganders. The program has saved lives, improved lifestyles and reduced overall costs for the entire health care system as well as for taxpayers," he said in a statement. "I appreciate the strong working relationship with my legislative partners that led to this framework, which ensures the continuation and sustainability of the Healthy Michigan program."

The bill is not necessarily about saving money for the state, said Sen. Mike Shirkey, R-Clarklake, the sponsor of the bill.

"This is all about finding more workers," he said. "Every business owner I know is searching for workers from the entire spectrum of jobs from the entry level to the high skilled jobs and the richest source of that for us are the able-bodied folks that are covered under Healthy Michigan."

Sen. Joe Hune, R-Gregory, said he was opposed to Healthy Michigan in the first place, but thought work requirements were an appropriate thing to add to the program.

"I don't think there is any problem, when you're receiving free health care, for the government to say you need to do a little bit of work in order to receive that. It's what this country was built on, so let's pull up our bootstraps and get to work."

The Senate, on a mostly party-line 25-11 vote, concurred in changes made to the bill in the House of Representatives on Wednesday.

But Democrats were still united in their opposition.

"This legislation is a twisted joke," said Sen. Coleman Young II, D-Detroit. "Even with the changes made in the House, it’s still a turd, a shiny turd, but a turd nonetheless."

Sen. Rebekah Warren, D-Ann Arbor, said without including provisions for things like child care and transportation, "We’re setting (Medicaid recipients) up to fail."

The bill is a compromise from what was initially proposed, which included a 29-hour workweek requirement and a controversial provision that would allow counties that had unemployment rates of 8.5% or more to be exempt from the work requirements. That would primarily benefit rural counties, but not urban cities such as Detroit, Flint and Saginaw that are in counties that have lower overall unemployment rates.

That provision was stripped out of the bill, in part, because it would cost the state Department of Health and Human Services too much to administer. But it also would have affected minority communities much harder than the rest of the population.

Michigan has about 2.4 million people who get health care coverage through Medicaid. A majority are elderly, disabled or children, but in 2013, the Legislature passed the Healthy Michigan law to expand Medicaid to low-income Michiganders and 680,000 people signed up. Shirkey estimated that about 350,000 of the Healthy Michigan recipients will have to comply with the 80-hours-a-month work requirement.

The movement toward requiring work for Medicaid coverage is growing across the nation with three states already requiring work for benefits and the administration of President Donald Trump reviewing requests from seven other states. The administration told Medicaid administrators earlier this year that it would support such requests and Trump signed an executive order last week asking for work requirements for recipients of federal benefits, such as food stamps and Medicaid.

Medicaid recipients would have to submit reports monthly about their compliance with the new rules, which also allow for the requirements to be met through school, vocational or job training, internships and community service. The requirement is waived for a recipient in substance abuse treatment.

Other changes made in the original bill:

Making only the people in the Healthy Michigan program — the 680,000 of the 2.4 million people on the plan — subject to the work requirements.

Changing the age of people who must comply from 19-64 to 19-62.

Giving people a three-month grace period each year in case they are seasonal employees and, as Shirkey put it, “life happens.”

Having the bill take effect on Jan. 1, 2020, instead of 2019.

Maintaining a 48-month limit on benefits.

Among the people who would be exempt from the work requirements: pregnant women, people ages 19-20 who had been in the foster care system; disabled people and their caretakers; caretakers of a family member under the age of 6; full-time students; the medically frail, and people who have been incarcerated within the last six months.

The new work rules are expected to cost the state at least $17.5 million to administer because of the extra workers needed to verify the hours worked by the recipients and upgrades to computer systems. But, according to an analysis done by the House Fiscal Agency, it’s also expected to save between $7 million and $22 million because of lower numbers of Medicaid recipients.

Snyder didn't support the original version of the bill, but said last week that the negotiations with the Legislature were on the right track.

Despite Snyder's support, groups advocating for low-income Michiganders still sent letters to the governor urging him to veto the bill when it reaches his desk.

"The 680,000 people who rely on this life-saving health care coverage deserve better than politically charged policies," wrote the Michigan League for Public Policy. "They should know that they have this all-important safety net when necessary."

The Michigan Disability Rights Coalition wrote: "A person who has applied for Social Security Disability, but has not been federally designated as disabled, would not be exempt under this legislation. A person with cancer undergoing chemotherapy who is not always capable of working may lose Medicaid because they cannot meet the number of work hours required. People who are not gainfully employed, but do not meet the required hours, will lose their health and even their jobs as a result. That is counter to what the legislation purports to intend."