BY: CLARA BATES
Missouri Independent
Over 90,000 Missourians could lose their Medicaid coverage under a proposal by Congressional Republicans to implement work requirements, according to a pair of recent studies of the plan.
A Republican reconciliation bill still being negotiated in the U.S. House contains various proposed changes to Medicaid — among them work reporting requirements — to pay for an extension of President Donald Trump’s 2017 tax cuts. A preliminary Congressional Budget Office estimate found over 8 million people nationally could lose coverage under the House legislation.
The work requirements would apply to adults on Medicaid between ages 19 and 64, requiring them to report at least 80 hours of work per month or qualify for an exception. The exemptions include people with disabilities, caregivers and pregnant participants.
A report from the Urban Institute and Robert Wood Johnson Foundation published last month found between 84,000 and 96,000 Missourians ages 19 to 64 could lose coverage under the plan. Another report, from the left-leaning Center for Budget and Policy Priorities published last week, estimated a reduction of 91,000 Missourians.
The CBPP analysis found that although 28% of Missouri Medicaid participants in the adult-expansion group could lose coverage, only 8% didn’t work in the last year and don’t qualify for an exemption — meaning thousands of eligible participants would lose coverage.
Work requirements in the current version of the legislation would go into effect in 2029, though there are reports Republicans are considering moving up the timeline.
States would be required to monitor compliance and ensure those with exceptions don’t get kicked off. Participants would need to navigate red tape to prove they’re working or exempt.
New bureaucratic hurdles could prove especially problematic in Missouri, which has historically fared poorly with administration of its public assistance programs. Missouri’s social services agency has struggled to meet federal standards for processing Medicaid applications and is being sued for its administration of the Supplemental Nutrition Assistance Program.
Administrative issues — such as long call center wait times, application delays and paperwork issues — routinely cause Missourians who are eligible for benefits to be incorrectly booted from benefit programs.
At a legislative hearing for a proposed work requirement in Missouri earlier this year, opponents said work requirements on Medicaid would only exacerbate the social service agency’s call center wait times and staffing issues.
One in five Missourians is enrolled on Medicaid. Most adults on Medicaid are already working or would qualify for an exception, but work reporting requirements would cause many to fall through the cracks, experts say, including low-wage workers with unpredictable hours. Opponents of work requirements also say Medicaid is a crucial safety net for workers who are laid-off or fired for reasons beyond their control and lose employer-sponsored health care.
U.S. Sen. Josh Hawley has been a vocal opponent of Medicaid cuts but has said he is supportive of work requirements.
“Listen, if you want to do work requirements, I’m all for that,” he told CNN last week. “I bet every Republican, and I bet most Americans would agree with that.”
Arkansas was the first state to adopt Medicaid work requirements in 2018. Until a court halted the program in 2019, over 18,000 people lost coverage, many of whom didn’t know about exemptions or couldn’t navigate the red tape. Studies found Arkansas’ policy didn’t result in increased employment.
Georgia’s Medicaid work requirement program has been mired in technical issues, ProPublica has reported, and the increased requirements for state employees to verify work status have proven onerous and expensive.
Other proposed Medicaid changes in the U.S. House budget include more frequent eligibility checks, out-of-pocket copays for some enrollees and freezing the tax states levy on providers to help fund the program.
The federal budget bill is expected to continue being negotiated in the coming weeks.