Bill forcing Michigan Medicaid recipients to work nears final OK

Kathleen Gray | Detroit Free Press

LANSING – After negotiations with Gov. Rick Snyder, the Legislature is poised to pass a bill that would require about 350,000 able-bodied Medicaid recipients to work at least 80 hours per month.

The Republican effort to add work requirements mirrors actions in many other states that is making the Medicaid expansion that was allowed under the Affordable Care Act a little more difficult for low-income individuals to get.

But 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.

“We’re getting rid of the qualifier for unemployment in a given county because the department (of Health and Human Services) told us it was going to be an egregious thing to administer,” said Sen. Mike Shirkey, R-Clarklake, who is the sponsor of the legislation. “It was not worth the investment.”

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 a law to expand Medicaid to low-income Michiganders and 680,000 people signed up. Shirkey estimated that about 350,000 of the Medicaid recipients will have to comply with the 80-hour-a-month work requirement.

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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.

The House Appropriations Committee passed the bill on a party-line 17-10 vote with Republicans supporting it and Democrats opposed. Republicans in the full House of Representatives cut off debate on the issue before a vote was taken and the measure passed on a 62-47 vote, with Rep. Martin Howrylak, R-Troy, joining all the Democrats in opposing the measure.

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, 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.

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 six; full-time students; the medically frail, and people who have been incarcerated within the last six months.

The plan is not meant to save money for the state, Shirkey said, but “it’s to find more workers.”

It’s also 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.

Democrats were opposed to the bill because they feel it's unnecessary since many Medicaid recipients are already working and it punishes people by taking away health care. They're also worried that a provision in the bill would automatically end the Healthy Michigan program if the federal government doesn't approve a waiver within a year of submission.

"Medicaid is not a jobs program. It is a health care program," said Rep. Yousef Rabhi, D-Ann Arbor, who offered an amendment that failed to strip the work requirments from the bill. "It is cruel and unusual for an institution like this to be stripping health care from thousands of Michigan residents."

And while Snyder said during the Mackinac Policy Conference that negotiations on the work requirements were headed in the right direction, he didn't on Wednesday give a guarantee of signing the bill.

"We're continuing to work with our legislative partners as it moves through the process," said Snyder spokeswoman Anna Heaton.

The Senate is expected to concur in the changes made to the bill — SB 897 — on Thursday.

Contact Kathleen Gray: 313-223-4430, kgray99@freepress.com or on Twitter @michpoligal.