PAR Mail 2018-067 | April 13, 2018
Medicaid Work Requirements Bill Advances
Protections included for people with disabilities
On Tuesday, April 10, 2018, the Pennsylvania House Health Committee gave approval to a bill that would impose work or work search requirements for individuals receiving Medicaid, the state's medical assistance program and the program that pays for disability services and supports in the Commonwealth. HB 2138 does contain a series of exemptions, further than those contained in last year's similar bill that was vetoed by Governor Tom Wolf.

Specific exemptions to the work requirement include:

  • An enrollee who is attending high school full time.
  • Someone receiving temporary or long-term disability benefits.
  • A resident who is under 20 years of age or those who are 65 and older.
  • Pregnant women.
  • Residents who receive SSI.
  • An individual residing in a mental health or correctional institution.
  • A resident experiencing a crisis, serious medical condition or temporary condition which prohibits employment, such as domestic violence or a substance abuse disorder.
  • Those persons acting as a primary caregiver to a dependent under 6 years of age or is permanently disabled.

The issue of a Medicaid work requirement has been a consistent issue brought up by majority party legislators during testimony opportunities with Teresa Miller, PA Secretary of the Department of Human Services. Secretary Miller has urged legislators to fully study the issue of a work requirement and be cognizant of the potential for costs of administering such a program outweighing potential benefits.
During her Senate confirmation hearing and House appropriations hearing, Miller said implementing the requirements could be too expensive — estimating the project could run up to $600 million in the first year. Plus, she added, she thinks the requirements contradict the point of Medicaid. Miller noted that people who need Medicaid health assistance “are, in many cases, facing significant barriers to employment — facing addiction issues or physical or mental health issues, lack of education issues, criminal history, lack of affordable, reliable childcare. We shouldn’t be penalizing people, we should be looking for opportunities and ways to address their barriers. We shouldn’t be taking away people’s access to healthcare.”

Proponents of HB 2138 believe their new bill may address many of the Secretary's concerns. Some advocacy organizations, including the Arc of the United States and ANCOR, PAR's national disability provider association, worry that such legislation has the potential to continue to negatively impact people with disabilities, noting that the state ultimately controls the definition of disability and may not cover all individuals with a disability under the definition.

PAR will continue to monitor this legislation.
Work Requirements Also Considered for SNAP (food stamps)
The PA House is also considering HB 1659, a bill that seeks to impose limits on SNAP (food stamps) eligibility.

Under the proposed bill, participants would be required to be engaged in one of the following:
  • employed for at least 20 hours per week
  • engaged in at least 24 hours of community service per month
  • participate in a work program for at least 20 hours per week
  • be enrolled as a full time student in an institution of higher education

The bill exempts an adult recipient who is a single parent with custody of a child under 12 and a person determined not to be able bodied by the Secretary of DHS.
Editorial Writers For And Against Medicaid and SNAP Work Requirements

Trib editorial: Pa.'s deepening Medicaid dependency

Even by liberal ciphering, such a large number warrants attention: Nearly half a million healthy, out-of-work Pennsylvanians reportedly with no income are on Medicaid, according to Department of Human Services figures cited by the Commonwealth Foundation.

To put that figure in context, it's more than the populations of Harrisburg, Allentown, Lancaster, Erie, Scranton and Reading — combined. And if those who are entangled in government's “safety net” have no income — and no incentive to gain any — exactly how do they lift themselves out of the maw of government dependency?

Since ObamaCare's expansion of Medicaid, program spending in Pennsylvania has increased at more than twice the rate of the state's economic growth, according to the Commonwealth Foundation. At the same time, an influx of able-bodied Medicaid recipients is taking a discernible toll on those in need of home- or community-based services. According to the Foundation for Government Accountability, 9,728 Pennsylvanians are waiting for those services — and 154 who were on waiting lists have passed away.

Yet state officials say moving people from Medicaid to work would be expensive, costing the state $600 million by one estimate. But other states have paid considerably less, such as Kentucky, spending $170 million to address 350,000 healthy adults on the government's dole.

Pennsylvania lawmakers cannot simply ignore a commonsense Medicaid work requirement for able-bodied recipients.

Work requirements for people who need public assistance don't work

Proposed work requirements for public benefits, such as those in Pennsylvania House Bills 1659, 2024, and 2183, are a bad idea. Work requirements for public benefits sound reasonable in theory, but are actually harmful and costly to Pennsylvania — and undermine highly effective programs, such as SNAP (food stamps) and Medicaid.

Programs requiring work to receive public benefits hurt working families and punish those who cannot work because they have a disability or are caring for children of a disabled family member.

Work requirements don’t help people struggling to get jobs. To the contrary, they take health coverage, nutritious food, and other necessities away from families, making it more difficult for them to find or keep jobs. All the while, work requirements create costly red tape for taxpayers.

Elected officials should reject policies that add red tape and focus more on policies that help workers, such as raising the minimum wage, investing in job training, and making child care and transportation more accessible.

Most people receiving benefits who can work do work, but when wages aren’t enough, or when someone is struggling to find a job or can’t work, it’s important that people be able to care for themselves and their families. Fully 70 percent of Americans will turn to an assistance program to make ends meet at some point during their lives. Public benefits systems, such as Medicaid and the Supplemental Nutrition Assistance Program , are in place to protect all of us when we fall on hard times.

Rather than helping working families move forward, work requirements cause workers to lose benefits when their hours fluctuate, when they cannot navigate complicated paperwork, or when the public assistance office makes a mistake or doesn’t process paperwork on time.

Low-wage workers need all of the stability that they can get. When they struggle to eat, or can’t receive the medical care they need, they are at great risk to lose the jobs they have and struggle to find new jobs.

When work requirements are implemented, people without access to transportation or child care lose benefits. Work requirements also harm other people with barriers to employment, including people who have been involved with the justice system, youths aging out of foster care, people who are homeless, and others who struggle with finding employment.
Cutting off people’s basic living standards by taking away their nutrition assistance or medical insurance only makes it harder for them to stay healthy so they can get back on their feet.

Not only do work requirements strip people of benefits they’re otherwise eligible to receive, they also drain state taxpayer funds. Work requirements are difficult and expensive to administer, and states must pay much of those costs.

Rather than draining limited state resources on new bureaucracies that don’t work and punishing people who are already facing economic hardship, members of the Pennsylvania legislature should focus on policies that create jobs and boost wages by addressing barriers like transportation and child care.