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Alabama to impose work requirements for some beneficiaries

Chip Brownlee

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By Chip Brownlee
Alabama Political Reporter

The Alabama Medicaid Agency said Thursday that it will seek a waiver from the federal government to begin imposing work requirements on some of those who receive benefits from the program.

The agency plans to hold two public meetings next week in Montgomery and Hoover to provide an opportunity for individuals and groups to submit suggestions and comments on the planned waiver application.

The proposal would place a requirement on unemployed, able-bodied adults to gain employment or participate in vocation school or job training.

“This change will put Alabama on a path to better health outcomes,” a notice sent by Medicaid Agency Commissioner Stephanie Azar.

The public hearings are part of a requirement for the Medicaid Agency to solicit feedback over the next 30 days before submitting a final application to the Federal Centers for Medicare and Medicaid Services.

With the application, Alabama would become one of nearly a dozen mostly Republican states that are seeking such a waiver from the federal government.

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Gov. Kay Ivey said in January that she has directed Azar to begin working on seeking a waiver for the requirements and raising co-pays for beneficiaries. States are typically required to request waivers from the federal government for changes to their Medicaid programs.

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“That process has been ongoing, and I look forward to the future implementation of those policies,” Ivey said then.

The Trump administration in January issued guidelines for states wanting to test the requirement and has signaled that it would approve the waivers, a shift from previous administrations’ policies that did not allow states to institute such a requirement.

Such a requirement, never before implemented in the 50-year history of the program, would force adult, able-bodied Medicaid beneficiaries — only about 7 percent of the state Medicaid population in total — to get a job or risk losing their coverage.

The requirement would be directed at those in the program who qualify as Parent or Caretaker Relatives — about 75,000 people. Those who qualify as Parents or Caretaker Relatives generally care for another person who also receives Medicaid.

Alabama already has one of the lowest adult working-age Medicaid enrollments in the country with the majority of those on the program being children, pregnant women and low-income seniors. In November 2017, 52.3 percent of Medicaid beneficiaries were under the age of 18. Another 15 percent were low-income or disabled seniors over the age of 60.

The children, disabled and elderly wouldn’t be subject to the requirement.

Alabama’s qualification requirements are already extremely strict. To qualify for the POCR coverage, a person must make 18 percent of the federal poverty level or less, which amounts to about $2,963 for a family of two — that’s less than $247 a month. For a family of three, the benefits cut off above $3,740.

The plan would likely boot thousands off Medicaid. Someone who works a part-time minimum wage job for 20 hours a week, making only $580 a month while caring for a family member, wouldn’t qualify.

“We will not improve the health of people in our state, nor will we improve the state’s economy, by forcing people to work when they are not healthy,” said Sam Brooke, a deputy legal director for the Southern Poverty Law Center. “This proposal would unnecessarily increase the burdens of the working poor, and end up costing the state more money by cutting people from the Medicaid rolls and forcing them and their families to use emergency rooms – subsidized by taxpayers – for routine health services.”

The SPLC said only holding two public meetings in Montgomery and Hoover only six days after announcing the plans could open the state to costly litigation.

Eleven states, all but one of which has a Republican governor, have already submitted waivers. One state, Kentucky, has had their waiver approved, and another southern state, Louisiana, which has a Democratic governor, has said they make also seek a waiver.

The SPLC filed a federal lawsuit against the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services after the federal agency approved a Medicaid waiver request from Kentucky.

“The proposal from Gov. Kay Ivey and Alabama Medicaid Commissioner Stephanie Azar is a solution in search of a problem. It is based on an absolute falsehood and vilification of those on Medicaid,” Brooke said.

Though Medicaid wouldn’t need approval from the Legislature to move forward with implementing work requirements, Sen. Arthur Orr, R-Decatur, has proposed a bill that would require the agency to implement the requirements. That bill was carried over in the Senate last week.

The program, if implemented, would allow the state to weigh factors like employment, skills training, job-searching and education when deciding which individuals can qualify for Medicaid.

Republicans say the measure would save the state money and would incentivize beneficiaries to get a job. Ivey said the move could be a cost-saving measure for Medicaid, Alabama’s biggest budget item.

Ivey’s office said last month the move was aimed at increasing efficiency and decreasing costs “in an effort to be good stewards of taxpayer dollars.”

The Legislature would not have to move on the work requirements. If the federal government’s Department of Health and Human Services approves the waiver, the state Medicaid Agency will be able to move forward with implementing the requirement.

Public hearings

Monday, March 5 at 11 a.m.
Alabama Industrial Development and Training (AIDT) Auditorium
One Technology Court
Montgomery, AL 36116
(BY PHONE):
Call 800-230-1059.
Confirmation Number:  445471#.

Tuesday, March 6 at 11 a.m.
Hoover Public Library Auditorium
200 Municipal Dr, Hoover, AL 35216
Hoover, AL  35216

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