Feds Nix Ohio Plan to Tying Expanded Medicare Benefits to Work, Training, ‘Engagement’

Inside DMV, people standing in line


The Biden administration has squelched a fledgling Ohio program requiring those in their prime working years receiving Medicaid health coverage to get a job to remain covered.

Chiquita Brooks-LaSure, administrator of the Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMMS), on Wednesday withdrew approval of a pilot program the Trump administration had approved in March 2019 that would have required able-bodied Medicaid health insurance ages 19-50 to work unless they were attending school, getting job-training, taking care of family members, or doing other “community engagement” for least 80 hours per month in order to receive the medical benefits.

Implementation of the program, set to begin in January had been put on hold during the COVID-19 pandemic.

But Brooks-LaSure’s 23-page letter to the Ohio Department of Medicaid cited a litany of potential lingering effects of the pandemic as the reason for withdrawing the waiver granted 17 months ago altogether.

“Uncertainty regarding the current crisis and the pandemic’s aftermath, and the potential impact on economic opportunities (including job skills training, work and other activities used to satisfy the community engagement requirement), and access to transportation and affordable child care, have greatly increased the risk that implementation of the community engagement requirement approved in this demonstration (program) will result in substantial coverage loss,”  Brooks-LaSure wrote.

“In addition,” she added, the uncertainty regarding the lingering health consequences of COVID-19 infections further exacerbates the harms of coverage loss for Medicaid beneficiaries.”

The Ohio Department of Medicaid, in a white paper done in preparation for seeking the creation of the program, found 253,638 of the 613,000 recipients in late 2018 had jobs, while another 250,193 qualified for continued coverage under the proposed criteria under one of the exemptions.

The study could not determine at that time if the precise status of the remaining 109,258 would qualify the stalled guidelines.

Indeed, the CMMS administrator challenged the premise the program would increase employment opportunities as, prior to the receipt of the program waiver, various research papers had shown many targeted for the program already had jobs or otherwise already qualified under the plan’s requirements.

“This makes it challenging for community engagement requirements to produce any meaningful impact on employment outcomes by incentivizing behavioral changes in a small fraction of beneficiaries,” the letter said, “all the while risking substantial coverage losses among those subject to the requirements.”

Research in the letter suggested 115,000 to 163,000 of the 700,000 Ohioans covered by the expanded Medicaid program for working-age adults could lose their access to health care. The Ohio Department of Medicaid, according to the letter, had pegged the potential dropoff as 36,000.

The Ohio Medicaid department will be given the opportunity to appeal.

Buckeye Institute: The worthiness of work

Political reaction to ruling fell along predictable party lines, as both Republican Ohio Governor DeWine and U.S. Senator Rob Portman blasted the decision as “extremely disappointing” and Democrat U.S. Senator Sherrod Brown lauded the HHS move.

Portman said the pilot program would have benefitted recipients able to work while slowing the financial impact the expanded Medicaid has on taxpayers for adult recipients younger than retirement age.

“I will continue to work for bipartisan, common sense solutions to address the affordability of health care and the long-term budget implications of Medicaid at the state and federal level,” Portman said in his statement.

Brown called the work, training, and community engagement requirements “a barrier” and “burdensome.”

“We should be making it easier for Ohioans to access care, not harder,” Brown said in an emailed statement sent to The Ohio Star.

But the economic research affiliate of the free-market Buckeye Institute warned killing the program before it began was “ill-considered,” as it will discourage more able-bodied Ohioans from joining the workforce.

“This misguided policy reversal will make it harder for people to gain new skills and valuable work experience, which Buckeye Institute research shows can lead to better job opportunities and higher lifetime earnings,” said Rea S. Hederman Jr., executive director of the Economic Research Center at the Institute in a news release.

“This decision,” he said, “only reinforces the fact that Medicaid reform — that protects the most vulnerable and helps healthy, working-age adults lead more prosperous lives — is desperately needed.”

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Brian Ball is a reporter for The Ohio Star and The Star News Network. Send tips to [email protected]
Photo “Waiting in line” by Jay Cross CC 2.0.


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