Medicaid Work Requirements Would Strain Hospital and State Budgets

(Photo: ERproductions Ltd / Getty Images)(Photo: ERproductions Ltd / Getty Images)

Louisiana state officials warned earlier this year that thousands of elderly and disabled people would be evicted from nursing homes if lawmakers failed to reverse course on Medicaid cuts and solve the state’s ongoing budget crisis. (Lawmakers later moved to shield the elderly and disabled from spending cuts but have yet to pass a budget.) In Kentucky, Republican Gov. Matt Bevin proposed raiding $201 million from a health care fund for state workers to balance the state’s budget, a move that critics said would rob cost savings from Bevin’s employees.

For conservatives opposed to tax hikes, balancing budgets needed to keep schools open and hospitals running in cash-strapped states is not easy. By placing work requirements on adults in state Medicaid programs that provide health coverage for low-income people, Republicans in 11 states could make that job even harder.

Kentucky expects its work requirements to reduce Medicaid rolls by 15 percent, which means about 100,000 people would lose coverage in an average month.

By expanding coverage for millions of people, the Affordable Care Act’s Medicaid expansion reduced un-recouped costs at hospitals and in emergency rooms and funneled billions of dollars in new federal funding into state coffers. Kentucky alone was expected to realize a net fiscal benefit of $919 million from 2014 to 2021 as a result of Medicaid expansion, including nearly $100 million in savings, according to one state analysis commissioned before Bevin was elected.

Bevin and other Republicans have a different idea for saving money: Reduce the number of people covered by Medicaid. Unable to repeal the Affordable Care Act in Congress, the Trump administration and its allies in state government are chipping away at Medicaid expansion by applying for federal waivers to place work requirements and other conditions on enrollment. Kentucky expects its work requirements to reduce Medicaid rolls by 15 percent, which…

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