Analysis: Medicaid work requirements take effect Jan. 1: difficulties likely for the poor

by Madeleine Graham

A law establishing work requirements for about 270,000 Medicaid recipients in Michigan takes effect Jan. 1, 2020–sending state officials and recipients scrambling to understand how they will be affected.

“At this time what we have to do is prepare to implement the law as it is written currently,” according to Bob Wheaton, public information officer of the Michigan Department of Health and Human Services (MDDHS).

Letters notifying recipients who fall under the requirements started going out in September and will continue through December, Wheaton said.

Bob Wheaton (Photo from LinkedIn)

“To clarify, the work requirements are for people enrolled in Healthy Michigan Plan (HMP), which is Michigan’s expanded Medicaid.  People enrolled in traditional Medicaid are not subject to the work requirements,” Wheaton said.

The previous administration, under former Gov. Rick Snyder and former head of the MDHSS Nick Lyon, began to institute the work requirements under a pilot program approved by the Trump administration called the “1115 Waiver” program.

People can meet the work requirements by:
*Employment or self-employment, or having income consistent with being employed or self employed
*Education directly related to employment including but not limited to high school equivalency or postsecondary education
*Job training directly related to employment
*Vocational training directly related to employment
*Unpaid workforce engagement such as internship
*Tribal employment programs
*Substance use disorder treatment,
*Community service completed with a non-profit (maximum allowable of three months in a 12 month period)
*Job search directly related to job training

Barriers to employment

Many Medicaid enrollees face barriers to work such as functional disabilities, serious medical conditions, school attendance, and care-taking responsibilities. Many Medicaid adults do not use computers, the internet or email, which could be a barrier in finding a job or complying with policies to report work or exemption status.

Controversial requirement

Because of these difficulties and other arguments, work requirements are controversial and were opposed by the Obama administration.  Current Michigan Gov. Gretchen Whitmer also opposes them.

However, on Sept. 23, Whitmer signed Enrolled Senate Bill 362 enabling the work requirements program along with other elements.

“The Healthy Michigan Plan (HMP) was a landmark bipartisan effort to cover 680,000 people increasing primary care usage and reducing emergency room reliance, and bolstering our economy,”  Whitmer stated in a press release.

System is backlogged

The system to help people prepare for the new requirements along with other bureaucratic challenges is backlogged, Wheaton acknowledged.

At Genesee and 49 others of the state’s 83 counties, DHS specialists are not assigned to any particular case because of what’s called the “Universal Case Load” (UCL)  system, explained Wheaton.

“We still need to make further improvement here, but have come a long  way.  Backlogs in handling case applications have dropped from 32 percent of cases to 6 percent in Universal Caseload counties.”

Previously, caseworkers were assigned to clients at DHS.  Theoretically, the UCL was developed to streamline those applying for benefits so that any specialist could answer questions.

“No example of a success” 

Work requirements efforts have been tried in nine states so far. Many are being challenged in the courts, as in Arkansas and Kentucky.

“There is no example of a successful requirement for people on assistance for medical, food stamps and cash assistance to work,” stated Darryl Douglas, PsyD., who formerly taught psychology at the University of Michigan – Flint.

Amber Bellazaire, MPH and a policy analyst for the Michigan Municipal League (MML) acknowledged it had been tried in other states including Arkansas where it “failed miserably,” but stated Indiana has implemented a program still underway.

Whitmer has pointed out the work requirements in the Michigan program are more stringent than in other states, including Indiana.

Political minefield

Even though she opposes the program, “the Governor being subject to the Republican House and Senate has limited power,” Douglas said. “I believe she didn’t have a better option than to sign the bill (362) putting work requirements into effect,” Douglas stated.

And, in fact, the state’s new budget signed by the governor Sept. 30 includes a $6.1 million General Fund transfer to the Healthy Michigan Plan Administration to support implementation of new work requirements.

“My administration is doing everything in its power to facilitate compliance with work requirements,” Whitmer stated.  “The MDHHS is partnering closely with health plans, providers and community organizations to communicate with program participants wherever they are.”

“With the encouragement of numerous stakeholders, the Department will defer implementation of new healthy behavior and premium requirements [privatizing many services] until Oct.  1, 2020, in order to focus on successful implementation of the work requirements,”  she said.

Time will tell the tale of the outcome for work requirements.

EVM Staff Writer Madeleine Graham can be reached at

Author: East Village Magazine

A Non-profit, Community News Magazine Since 1976

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