The Burden Of Proof; Politicians Spar Over Medicaid Work Requirements In MI

Dec 9, 2019

As lawmakers in Lansing extend olive branches to make a deal on the state budget, public disagreements over Medicaid work requirements continue.


The Governor made a plea to Republicans in the legislature in a letter last week  asking them to authorize similar actions that the Republican supermajority in Indiana allowed while there is ongoing litigation.

“If the courts block these requirements, this money will be wasted. Even if the courts only temporarily block them – as they have done with similar programs in other states – the state risks wasting money and creating confusion for thousands of Michigan families,” said Whitmer.

Whitmer’s letter alleged $28 million has already been spent preparing for the program and the state is on track to spend $40 million more in fiscal year 2020 according to the Michigan Department of Health and human Services.

What’s On The Line

Beginning January first anyone who’s between nineteen and sixty-two years old and on the Healthy Michigan or Medicaid expansion plan will have to prove they’re working 80 hours per month to continue receiving healthcare or prove themselves exempt.

You can be exempt for things including being a student, being in job training, or a caregiver.

As of December 9 MDHHS reports  651,900 people are enrolled in the Healthy Michigan plan, and nearly 1.7 million are receiving Medicaid benefits across the state.

To receive Healthy Michigan, you must be below 133% of the federal poverty level.

Legal Challenges Muddying Waters

A lawsuit filed November 22nd challenges the legality of the waiver in Michigan on behalf of low income Michiganders. All of the other states with work requirements have temporarily placed theirs on hold or judges have issued injunctions against the program, stopping them from being enforced.

According to one of the groups representing plaintiffs in the legal challenge against Healthy Michigan work requirements some studies estimate between 61,000 and 183,000 people will lose their coverage

Governor Gretchen Whitmer has been vocally opposed to work requirements, which were signed into law before she was inaugurated as Governor. Michigan is one of five states including Arizona, Iowa, Indiana and New Mexico where the federal government has approved waivers, so the states can enforce work requirements for people receiving care through expanded Medicaid in the state.

“Unfortunately, I need the legislature to work with me on that. And so that’s I think the challenge here, but that is also the most reasonable thing to do. As you know Indiana is completely Republican controlled and they saw the wisdom in that and I’m hopeful that we can find some common ground there as well,” said Whitmer.

However, after receiving the Governor’s request last week state Senate Majority leader Mike Shirkey said the Michigan work requirements are different from other states, so there is nothing to be worried about.

“We’re going to send a response back to the Governor thanking her for her letter. But we believe what we did was perfectly lawful. We think Michigan’s work engagement requirement is uniquely different than most other states. And so, we’re going to let the process play out and we’re going to continue to implement.”

The Question of Cost

Whitmer said she’s also worried about the cost. The letter alleged it would cost the state nearly $1 million to send out letters in early December notifying recipients of the policy change, and if the court orders the state to stop, it would cost another million to send letters reversing the change.

Robin Rudowitz is a co-director of the program on Medicaid and the uninsured at the Kaiser family foundation. She’s studies how Medicaid and work intersect. Beyond the cost of notifying Medicaid beneficiaries, there’s not sufficient evidence that work requirements yield tremendous cost savings for states.

Rudowitz said, for one, most people receiving Medicaid, are working. And the ones who aren’t would most qualify for exemptions.

For example, according to research conducted by the Kaiser Family Foundation, in Michigan 35 percent of Medicaid recipients are not working. Yet, of that 35 percent who report not working 11 percent say they are ill or disabled, 13 percent say they are caretakers, and 5 percent say they are attending school. All of these groups would likely qualify for the state’s exemptions.

Leaving just 7 percent of recipients surveyed who list an “other reason” for not working. There is no data specific to the people receiving expanded Medicaid in Michigan.

The Burden Of Proof

This type of program targets a narrow slice of the more than 600,000 people receiving expanded Medicaid in Michigan. And, asking people to report, could complicate access to healthcare even for people who meet the requirements.

“And we know that these types of reporting requirements often impose administrative burdens which may result in individuals who remain eligible falling off the rolls,” said Rudowitz.

Joanne Galloway is a retired farmer who’s on healthy Michigan. She’s been to some of the info sessions because she was worried about losing her care. She said she thinks the paperwork will intimidate people.

After going to a session Galloway said she thought, “Wow, there’s really not much to this. But the headlines will scare people. And the fact that you have to do the reporting and how difficult that might be initially will cause people to give up. And people will lose their healthcare not because it was too difficult, there was too many hoops.”

Healthy Michigan recipients will have to call-in or fill out paperwork to prove their exemption or work status for the first month, until the state rolls out its online component in February.

For now, people on expanded Medicaid in Michigan, will have to prove they’re exempt or working starting January first unless the Governor can make a deal with Republicans or the court steps in. If, the program starts, Michigan will be the only state with a waiver enforcing work requirements.

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