Virginia officials are moving to limit eligibility for Medicaid via work requirements, even as the state is set Thursday to make more poor Virginians eligible to sign up for the government-funded health insurance program.
The state will file a waiver with the Trump administration by Friday that would require certain people in Medicaid to work or train for work as a condition of staying enrolled in the program, just after opening the program to low-income residents a day earlier without such conditions attached.
Virginia’s Democratic Gov. Ralph Northam signed the Medicaid expansion into law after a five-year fight, begun under his predecessor, with the GOP-controlled legislature. Northam’s campaign had largely centered on the promise to expand Medicaid, and the agreement to add work requirements was a compromise to get enough Republicans on board in the state House to make it happen
Under the planned work requirement, certain Medicaid enrollees would need to work, volunteer, or take classes, and log their hours with the state. People would also have to pay premiums of up to $10 a month, depending on their income. If they were to skip the requirement for three months in a row, they would be knocked out of Medicaid.
Republicans in the state Senate believe the requirement that has come together is a watered-down version of what was promised.
“We don’t consider it to be a work requirement,” said Jeff Ryer, press secretary for Virginia’s Senate GOP caucus. “It has got exemptions you can drive a truck through. … We refer to it as a ‘work suggestion.’”
Republicans in the Senate had been opposed to the Medicaid expansion, but it had some support in the House as long as the work rules were tied in. Parker Slaybaugh, a spokesman for House Speaker Kirk Cox, said he “supports a strong and robust work requirement as was one piece of the conservative reforms which were included in the plan as it passed the General Assembly.”
The work requirement contains exemptions for people with disabilities, caregivers, pregnant women, and people who are medically frail, including people who have an addiction, people with HIV/AIDS, and the homeless.
Similar requirements have been approved in Arkansas, Indiana, New Hampshire, and Wisconsin, and the Trump administration is considering at least seven other state waivers.
But Virginia also adds “hardship exemptions,” such as being hospitalized, the birth or death of a family member, severe weather, or a divorce.
“It is certainly not a shock to us that the administration is not coming up with robust work requirement,” Ryer said of the governor’s office.
The Virginia governor’s office did not immediately respond to a query, but in an interview with the Washington Examiner in February, Northam said that he would prefer a “ carrot approach rather than a stick approach” for the work requirements.
“We want to make sure we help people get back into the workforce but not penalize them,” he said.
Critics have said the work requirements would get in the way of people accessing health insurance coverage, but proponents have said it could be a useful tool that will help people move out of poverty.
It’s not clear whether the Virginia waiver will be able to move forward. Arkansas is being sued for its waiver, which resulted in more than 8,462 people being booted from Medicaid, and the waiver approved in Kentucky was put on hold after a legal challenge.
In addition, the waiver in Virginia may take as long as two years to be approved, meaning that until that time, beginning on Thursday anyone who makes less than $16,745 a year will be permitted to enroll in Medicaid, regardless of work or disability status. About 400,000 Virginians are expected to enroll, many of whom were previously uninsured. The coverage will start Jan. 1, 2019.
Obamacare was originally written to have all states expand Medicaid to low-income people, but a Supreme Court decision made the provision optional.
Outside of the expansion, Medicaid covers pregnant women, people with disabilities, people in nursing homes, and children, a group that members of the Trump administration and conservatives say should remain the focus of the program.
As a result, states are in different places when it comes to Medicaid. Most have expanded, while others haven’t or are considering it. Idaho, Nebraska, and Utah voters will consider expansion through a ballot measure weighed by voters Nov. 6. Other states have not expanded.
The work requirements are one way that state lawmakers are seeking to target Medicaid funds and to reduce spending. The federal government picks up most of the share of expansion, but in 2019 states will pay for 7 percent of it. By 2020, they will spend 10 percent of the expansion.
Virginia is funding its share of expansion through a hospital tax, which is expected to bring in $306 million in revenues.
But Christina Nuckols, spokeswoman for the Virginia Department of Medical Assistance Services, said that the state considers Medicaid expansion to be a net savings, of about $355 million from 2019 to 2020, because the state was paying hospitals to care for people who were uninsured, many of whom will now be covered by Medicaid.
Until officials have an answer on the work requirement, Virginians will be able to enroll in the program without being employed and mostly without paying premiums.
To get the word out, state officials are spending $750,000 on TV, radio, and social media, and will spend $250,000 on brochures, flyers, and other paper services, Nuckols said. Officials also are considering posting billboards or ads at gas stations in rural areas and reaching out to parents with children on Medicaid as well as people receiving food assistance.
About 120,000 people may be eligible to move out of the Obamacare exchange market, called healthcare.gov, and onto Medicaid, according to a webinar the state held Wednesday. Advocacy groups including the Virginia Healthcare Foundation and the Virginia Poverty Law Center are helping people enroll.
“We are working to ensure that all who are eligible are getting that information and have the opportunity to apply,” Nuckols said.