Medicaid Expansion is On the Table, But Work Requirement Could Be Sticking Point

Jan 30, 2018

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In Virginia, Republican leaders are now saying they won’t talk Medicaid expansion unless Democrats support work requirements for the program. A bill to do just that made its way through a key committee this week.


Republican Speaker of the House, Kirk Cox, says the goal is to get people off Medicaid, and independent.


“Work’s a good thing. There’s dignity in work, and it creates a self sufficiency that a lot of

people really want,” Cox said during an interview Tuesday.


A work requirement isn’t likely to apply to those already on the rolls. Less than a third of current Medicaid recipients in Virginia are able-bodied adults. Of those, half already do work.


And critics argue working doesn’t always make people independent. At the Kaiser Family Foundation, Rachel Garfield points to welfare recipients -- who are required to get jobs.


“That program has had work requirements since 1996,” Garfield says. “So there is more than 20 years of research looking at what happened in that program.”  


She says there’s limited evidence work requirements help get people off the public dole. That’s because people who found work were poorly paid. Turning to the Medicaid program Garfield wonders how many low-income people could find jobs that offer health insurance.


“A key question is what kind of jobs people would move to,” she says. “And importantly for thinking about this in the context of Medicaid, is whether those jobs would come with health insurance coverage.”


Garfield says those programs that were successful provided strong support systems, to help people who are low-income deal with the barriers between them and a job.


“Things like not having childcare, not having transportation. Needing other kinds of help with their resume prep or interviewing skills.”


The Trump administration isn’t allowing states to spend federal Medicaid dollars on that kind of support. So if Virginia wanted to go that extra mile, the state would have to pick up the tab.


In a recent interview with RADIO IQ, Governor Ralph Northam says he’s in favor of a program that helps people find work, rather than one that requires it.


“It adds bureaucracy, and I think it puts people in awkward positions,” Northam said. “We’ll look at a work search program where we at least assist people that want to get people into the workforce.”


In a letter to Cox this week, Northam said he was ready to work together on Medicaid expansion, but didn’t mention work requirements.


In an interview, Cox insists a work search program isn’t enough.


“You don’t want a program by which you fill out an application at two or three places with no really intention to go to work. So, the actual work piece is the key,” Cox said. “And so that’s just not good enough. A work search is not work.”


An analysis of the proposed work requirement by the Department of Planning and Budget assumes it won’t actually apply to any current Medicaid recipients. But it would cost millions in additional red tape.


This report, provided by Virginia Public Radio, was made possible with support from the Virginia Education Association.