Most people probably would agree that work – the toil we all do to earn a living – is not always fun but it’s a necessary part of life. There is a reason why the word “work” is synonymous with effort required to earn a living that is often unpleasant. Many Red States have proposed to add work requirements to Medicaid eligibility. The Georgia Medicaid program is currently the only state in the nation to have a work requirement as a condition of eligibility, but other states have expressed an interest. This from U.S. News:
By now, Georgia officials expected their new Medicaid plan, the only one in the nation with a work requirement, to provide health insurance to 25,000 low-income residents and possibly tens of thousands more.
But a year since its launch, Pathways to Coverage has roughly 4,300 members, much lower than what state officials projected and a tiny fraction of the roughly half-million state residents who could be covered if Georgia, like 40 other states, agreed to a full Medicaid expansion.
The idea behind work requirements is the normative convention that receiving charity should come with some conditions. Furthermore, requiring work as a condition to enroll in Medicaid will also help transition some enrollees off Medicaid as their economic fortunes improve. A year into the experiment the enrollment numbers are low, just a fraction of what Georgia expected. However, it is not clear what that the numbers really mean:
Health and public policy experts believe the enrollment numbers, dismal even compared to what Kemp’s office had said Pathways could achieve, reflect a fundamental flaw: The work requirement is just too burdensome.Pathways requires all recipients to show at least 80 hours of work monthly, volunteer activity, schooling or vocational rehabilitation.
Critics of Medicaid work requirements complain Georgia’s requirements are too rigid, not taking into account enough exceptions.
…the program makes no exceptions for people who are caring for children or other family, lack transportation, suffer from drug addiction or face a myriad other barriers to employment. Then there are people with informal jobs that make documenting their hours impossible.
Those excuses ring hollow. These same barriers must be somehow overcome by everyone trying to earn a living.
Over the last year, Kinsell has suggested Pathways to about 30 patients who might meets its requirements, but none have signed up.“I think the general idea is it would be too much work and too complicated for little benefit,” she said.
It’s possible that many potential Medicaid enrollees simply do not perceive Medicaid as having much value even among those who already qualify. This raises the question: is the Georgia program a failure because enrollment is only 17.2% of the anticipated enrollment? Or does that make the program a success, since Georgia is not wasting money on people unwilling to meet basic work requirements? For that matter, Georgia is not spending money on Medicaid managed care benefits that many potential enrollees do not value. Is the Georgia experiment a failure because the program has not enticed poor enrollees to seek work in return for the benefit? Or perhaps 17.2% of potential enrollees is proof that Medicaid is an effective way to get more poor residents to seek jobs.
The Georgia Medicaid work requirement experiment has implications to other states that would like to implement their own Medicaid work requirements. The jury is still out on whether Georgia’s program is a success or a failure. It all depends on the endpoints you’re seeking, including saving taxpayers’ money or boosting employment among low-income residents.