Medicaid work mandate could cut coverage in NJ

Rules led to lost enrollment, not job gains, in AR,GA

By: Gene Myers
NorthJersey.com
USA Today Network - New Jersey

..... In New Jersey and the rest of the nation, sweeping changes are coming to Medicaid.
..... In two years, the One big, Beautiful Bill passed by Republicans in Washington will require millions of low-income Americans to work, study or meet similar requirements to keep their health insurance.
..... Supporters say that will put more people to work, and help shore up the program's finances. But in Arkansas and Georgia, the two states that tried such a requirement, the result has been a loss of coverage without a complementary increase in employment, studies show.
..... Can New Jersey do better? According to Kevin De Liban, litigation director for the nonprofit group Lea gal Aid of Arkansas, that will require avoiding the technical glitches, confusing reporting systems and administrative hurdles that tripped up enrollees in his state.
..... "The core issue was the avalanche of paperwork,: said De Liban, who led a federal lawsuit that overturned Arkansas' work requirement in 2019. "First there was mass confusion. In many states. Medicaid isn't even called Medicaid, so people often didn't know they had it, or what kind they had, or whether the work requirement applicants to their specific plan."
..... The new law mandates that many adult Medicaid recipients - typically those ages 19 to 64 who are not pregnant or formally deemed disabled - must log at least 80 hours per month in work, job training, education, care-giving or other qualifying activities. The mandate is expected to roll out nationwide by January 2027, after the midterm elections.
..... Arkansas; version, launched in 2018 under President Donald Trump's first administration, provides a case study of how things could play out. within five months of implementation, more than 18,000 of 67,000 eligible enrollees were dropped from Medicaid coverage.
..... Most were removed not beaus they had failed to abide by the new requirement but beaus they failed to report their activities on time," De Liban said.
..... An analysis by the nonpartisan Congressional Budget Office estimated the One Big, Beautiful Bill Act could lead to coverage losses for 11.8 million people over the next decade. The CBO cited both chances in eligibility rules and funding in the legislation as well as the potential impact of work requirements.
..... Republicans say the bill strengthens Medicaid by rooting out wasteful spending and ensuring the program remains sustainable for senior's children, people with disabilities and other vulnerable groups.
..... The bill is "the single strongest Medicaid package in our nation;s history" and "protects the needs of its intended beneficiaries," U.S. Representative Tom Kean Jr. (R-7) declared on social media. "Our package makes commonsense reforms to root out wast, fraud, and abuse, so we can support and preserve the programs that thousands of New Jerseyans on."
..... Work requirements are a necessity, supporters say, because Medicaid's rolls have swollen since the passage of the Affordable care Act in 2010. The program now covers 83 million people and costs approximately $870 billion annually.
..... "It is critical for Medicaid enrollees to have a stake in the taxpayer-subsidized benefits they receive, said Brian Blase, president of the Paragon Institute, a health care researcher that says it promotes market-based policies. "Work open the door to independence, enabling individuals to support themselves without government assistance and to access private health coverage."
..... Still, multiple studies have found work requirements mostly led to coverage losses, not job gains, in Arkansas and Georgia. In Arkansas case the people who lost insurance mainly did so due to missed paperwork. There was no increase in employment, according to research by the Urban Institute.
..... In Georgia, currently the only state with a work requirement, enrollment gains have been far below projections under the new rules - above 6,5000 enrollees compared to a five-year target of 64,000. Most of the program;s $40-plus million cost has gone to administration and consultants, not helaht care, according to the Kaiser family foundation, a Washington group that studies health care policy.
..... Medicaid is jointly funded by state and federal governments and administered on the ground by states, meaning it will be up to New Jersey officials to implement the new work requirements.
..... The Republican candidate in this year's governor's race. former state Assemblyman Jack Ciattarelli, didn't respond to a message asking about the Medicaid changes.
..... His Democratic opponent, U.S. Representative Mikie Sherrill, D-Montclair, noted that she opposed the bill.
..... "This bill adds red tape and bureaucracy that will make it harder to get care," Sherill said in an email. "Some organizations are already anticipating a significant increase in administrative costs, even as funding is shrinking. We know these changes will kick people with disabilities off Medicaid, which is one of the many reasons I voted against this horrible bill."
..... Avoiding coverage losses will require states to adopt more enrollee-friendly reporting system, said De Liban, the Arkansas attorney.
...... "States can take steps to minimize coverage loss, through it;s important to understand that some eligible people will lose coverage no matter what - that was the clear lesson from Arkansas," he said.
..... "States should broadly define exemptions and automatically apply them when possible, so people don't have to navigate paperwork. For those who do need to report, states should accept self-attestations and make the process simple."
..... In an interview, De Liban offers further insights into what it looked like on the groundwork work requirements were enacted in Arkansas and how other states might handle them.
Q: Who was affected most by the Arkansas Medicaid work requirement.
A: People who were working but didn't have stable jobs. People who had mental health conditions. People with disabilities. People who were caring for others. People who didn't speak English or who had low literacy. All those folks were disproportionately affected.
Q: You've said many people technically qualified for exemptions. Why did they lose coverage anyway?
A: They'd get confusing letters - sometimes one message one week, and then a completely different one the next. When they tired to call the state for clarification, they'd often be on hold for hours, and even if they got through, the information wasn't always helpful.
..... The paperwork itself could be 10 pages long. people had to verify they were meeting the requirements, and in Arkansas, the only way to do that was through an Online portal. That system required clicking through 10 to 2o screens - all with small fonts and unclear instructions.
..... you had to have login information, which had to be updated periodically or you'd get locked out. Even if someone successfully reported one month, they might not realize they had to do it again the next month. Some people had exemptions, but those expired after two or three months - and they had to keep track of all that.
..... The portal shut down at 9 P.M. every night. It didn't work on smartphones. If you didn't have Internet or a computer, you couldn't comply. We heard from people who were trying to report from public libraries, who were confused by the portal, or locked out.
Q: Was there a clear explanation of the new rules?
A: The notices were incomprehensible. I've had legal training and still had a hard time understanding them. We had advocates and case workers trying to walk people through it-and they couldn't make sense of it either.
Q: What's your response to those who say this was about preventing fraud?
A: That narrative is a myth. The real fraud is designing a system that you knew people won't be able to navigate, then blaming them when they fall.
..... There's almost no fraud on the part of Medicaid recipients in this country. Multiple studies have shown that. this whole "waste,fraud and abuse" idea is completely bogus when applied to people recipient Medicaid. There's essentially none of that happening among recipients.
..... Second, this framing - especially as it's being sued by Republicans - is meant to mislead. It denies the reality that medicaid helps people be in the best shape they can be, given their circumstances. It allows them to work, take care of others, go to school, and do all the other things we all consider part of a decent life.
Q: What's your advice to New Jersey as it prepares to implement the federal work requirements?
A: Outreach is also critical - but it must be smart and strategic. in Arkansas, people were confused by texts and calls that felt like scams, even when they were from the state. trust and clarity are essential.
..... States must also optimize there "export" renewal systems - where they sue existing data to automatically renew eligibility - to prevent unnecessary terminations. And they should be cautious when contraction with tech vendors like Deloitte or Maximus, ensuring systems work and contracts allow for fixes without huge costs.
..... Finally, states should collect and publish data on coverage looses and engage advocates early to hello shape policies and reduce harm.

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