Holdout states consider expanding Medicaid -- with work requirements

But Walton cautions that in places like Humphreys County, a work requirement might prevent Medicaid expansion from being much help at all.

“I know it would not be effective for this community if it’s a requirement,” Walton said. “Here, if you don’t have a job, you cannot even afford the gas — even if you have a vehicle to travel.”

Coverage gap

The Affordable Care Act, enacted in 2010 and also known as Obamacare, included a requirement that states expand Medicaid to cover all adults with low incomes up to 138% of the federal poverty level (about $20,780 for an individual) instead of limiting it to parents of young children and people with disabilities.

But in 2012, the U.S. Supreme Court ruled that Medicaid expansion was optional for states. Since then, the District of Columbia and 40 states have expanded the program; other states have not.

Mississippi and the other nine holdouts have resisted substantial financial incentives. The federal government covers from 50% to nearly 78% of the cost for people enrolled in traditional Medicaid, depending on a state’s per capita income. The federal share for the expansion population is 90%.

If every holdout state fully expanded Medicaid under the ACA, nearly 3 million uninsured adults would get coverage.

In Kansas, Mississippi and Wyoming, some lawmakers are pushing for work requirements as part of a full-fledged expansion, triggering the 90% match. Other non-expansion states, including Georgia and South Carolina, have asked the federal government to allow them to include work requirements in something less than a full expansion under the ACA. (States can make more people eligible for Medicaid, but if they don’t expand it to everyone making 138% of the poverty level, they don’t get the full 90% match.)

The idea of imposing a work requirement on Medicaid enrollees is not new: The Trump administration approved 13 states’ requests to do so. But the Biden administration and the courts rescinded those approvals, and now only Georgia, which is fighting the administration in court, has a strict work rule for any of its Medicaid enrollees.

Even without actual requirements, 60% of non-disabled, non-elderly Medicaid recipients work either full or part time, according to KFF, a health care research organization.

...continued

swipe to next page