Dear Governor: Four Medicaid Stories You Need to Know Before Imposing Work Requirements

Todd Muow’s Story: Healthcare red tape leads to suffering and death. Anyone who has dealt with public benefits programs like Medicaid knows they can be confusing and complicated.  When work requirements are added to the red tape burden,  decades of evidence from around the country shows that people fall off of programs as a result.

Each bureaucratic denial is not just a data point: it is a decision that can cause real suffering. In Iowa, quadriplegic Todd Muow died shortly after the state’s Medicaid program cut him off of his successful home care regimen. His case is one of hundreds in Iowa that have led to official complaints against a corporation and the state for wrongly denying care.  In California, twenty year-old Sarah Broughton died after a routine sinus infection was left untreated, and spread to her brain. Broughton had applied for Medicaid multiple times, but her application was routinely denied or delayed. The day after she died, Broughton’s parents finally received her approval for Medicaid.   

D’Ashon Morris’ Story: Profit-seeking contractors cannot be trusted with healthcare.  Many governors choose to contract out their state’s Medicaid duties to private corporations. Too often, those corporations increase their profits by denying care. In Texas, young D’Ashon Morris was left permanently brain damaged when his Medicaid care was reduced to a dangerously low level. That fateful decision to reduce Morris’ care saved money for the corporation that Texas pays to manage Medicaid, a common enough occurrence that it triggered an award-winning year-long investigation by the Dallas Morning News called “Pain and Profit.” Similar privatizing arrangements have caused an outcry in states like Iowa, where reduced care has led to lawsuits and complaints by both patients and providers.

Amber Thayer’s Story: State bureaucracy cannot be trusted with  administering a work requirement. The most powerful example of the catastrophic impacts of work requirements is the disastrous program recently rolled out in Arkansas. Before a federal judge ordered the program stopped, Arkansas kicked off more than16,000 people from healthcare.  Kentucky officials boasted that they plan to use similar work requirements to take healthcare away from 100,000 people.

Surveys showed that many of those kicked off in Arkansas likely were working or exempt but were tripped up by the red tape of the reporting process. That result was not surprising: studies by the Kaiser Family Foundation and other researchers  show that the vast majority of Medicaid enrollees who can work already do so. Others usually should be considered disabled or are caregivers, and thus exempt from the requirements.

But will those who are eligible be able to qualify for those exemptions? For states like Indiana, which is rolling out work requirements this year, the track record suggests that many will not. Indiana’s current requirement for nominal payments, like work requirements a departure from long-time Medicaid practice, had a devastating impact in just its first two years: Nearly 60,000 Hoosiers were either blocked from coverage or kicked off because they failed to meet the demand for premium payments. For the same reason, another 287,000 of the poorest Hoosiers were downgraded to a more limited amount of healthcare.  

One of those affected was Amber Thayer of Indianapolis. Indiana officials wrongly kicked Thayer off HIP due to administrative mistakes, preventing the homeless mother from seeking housing or a job. Instead, she had to spend each day cobbling together enough money for a single day’s medication, then walk to the pharmacy with her infant daughter. It took six weeks, multiple lawyers’ help, and two administrative hearings before the state and its contractors fixed their error.  Layering on work requirements to the existing dysfunctional programs will mean that millions of Americans on Medicaid will face new, additional barriers and inevitable administrative mistakes.

Adrian McGonigal’s Story: Work requirements can actually prevent work. Trump administration director of the Center for Medicare and Medicaid Services Seema Verma says the aim of work requirements is to “allow able-bodied, working age adults to experience the dignity of a job.”  That’s not how Adrian McGonigal experienced it.

McGonigal’s job at a food service company did not provide health insurance, so for four years he was able to get his prescriptions filled and go to the doctor, thanks to Arkansas’ Medicaid program. McGonigal was able to follow the work requirements reporting mandates at first. But he did not understand he was supposed to report in again each month.

One day, he went to refill his prescriptions and was presented with a bill for $800. The state had cut him off.  McGonigal could not afford to pay for the medicine, so he fell ill and had to miss days of work. He lost his job.

If work requirements take effect in the 15 states where they are planned, millions will endure what McGonigal did. Research shows that access to healthcare increases the likelihood of a person consistently working. As the documented outcomes of the Affordable Care Act prove, people who obtain health care are more able to seek and maintain employment.

Governor, these stories are sadly common, and you are on a course to add to this list. Work requirements will create a counterproductive red-tape mess that will hurt our sisters and brothers across the country. They will endure pain, unrelenting illness and even death. Is adding more stories of suffering the legacy you want to leave behind?