Some notes on Medicaid news from this week. First some good news:
This is the fourth successful campaign for a Medicaid ballot initiative. Voters in Idaho, Nebraska, and Utah will get a chance to decide whether to expand coverage. Mainers voted in favor of this last year.
— Jeffrey Young (@JeffYoung) July 5, 2018
People want healthcare. People want to be able to go to the doctor when something is not right and not worry that it will screw them over for the next decade because of debt. And the initiative process is one route forward. Emma Sandoe has noted that Nebraska’s unicarmal legislature has assembled a majority for Medicaid expansion in the past but not the super majority needed. The odds are probably pretty decent that Medicaid expansion will pass in the Cornhusker state.
Breaking News: A federal judge blocked Kentucky's plan to impose new Medicaid rules requiring the poor to work to maintain their health coverage. https://t.co/nwlElTdeoP
— NYT Health (@NYTHealth) June 29, 2018
A federal judge ruled that the Kentucky Medicaid waiver for work requirements is arbitrary and capricious and sent the approval decision back to CMS for reconsideration. CMS did nothing to consider the massive enrollment losses. He also noted that the point of Medicaid is to cover medical costs first and foremost. Everything else is a secondary point.
And now some messed-up news. Arkansas has work requirements for its Medicaid population. The first round of reporting ended last night and the early reports are that at least half of the people failed to jump through the paperwork:
11,000 enrollees who had to report whether they met the requirement or qualified for an exemption in June, more than 8,000 remained out of compliance as of late last week, Marci Manley, a spokesman for the state Department of Human Services, said in an email.
And in Catch-22 news, Mississippi modified their proposed work requirements. Remember, Mississippi does not have Medicaid expansion and they have very tight eligibility requirements in general (via Modern Healthcare:
Any person who works 20 hours per week in a minimum-wage position would earn $7,540 annually, but the state’s income eligibility cutoff is 27% of the federal poverty level, or an annual income of $4,444.
Work to meet the requirement and a non-disabled, non-pregnant adult makes too much for Medicaid and not enough to meet tax credit eligibility for a CSR Silver plan on the Exchange. Not work to keep Medicaid, and the work requirements limit Medicaid. It is one hell of a catch even as there are volunteer and job training options that don’t produce income that could qualify as “community engagement”.
Earl
Arkansas in 2016: 60.5% Trump. Lo, my field of fucks: it is barren.
Steeplejack
“Nebraska’s
unicarmalunicameral legislature.”WereBear
When I realized the full extent Trump voters were willing to suffer, per Cleek’s Law… my goodwill began to erode regarding them.
That is some #@(*&(*# up )*&^@ for certain.
bupalos
@Earl: This attitude of “I’m fine with whatever happens to poor people (who as a bloc basically vote D in every state) if they’re stuck in a state with 50+1% Trumpanzees” is completely counterproductive. Just not how it works. Those folks are if anything MORE deserving of sympathy, not less.
Fake Irishman
Mississippi does have an the ability to put a statewide initiative for expansion on the ballot on the off chance any one loves there and is looking for something to do.
Fake Irishman
@Fake Irishman:
I mean expansion, like minimum wage increases, is extremely popular even in deep red states. And MS has a very large AA community, which means that it would have a good floor to work from.
Mnemosyne
I honestly don’t see any rationale for Medicaid work requirements unless the assumption is that everyone on Medicaid is faking illness. Otherwise, it’s just punishing people for getting sick.
Roger Moore
@Mnemosyne:
You make it sound as if punishing people for getting sick isn’t a rationale. It’s an evil, stupid rationale, but it’s a rationale.
MomSense
The Medicaid gap is just the perfect example of cruelty.
Spanky
@Roger Moore: It’s the rationale.
It’s so much fun!
CodeWriter
@Earl: Thanks Earl, I’m sure the 39.5% of Arkansas that voted the way you think best are happy to know you don’t give a fuck about their problems. As someone born and raised in Wisconsin and financially unable to leave the state for at least the next 5 years I’ll be sure to also take your inevitable opinion of us into account while fighting against the corrupt politicians that have stolen and sold my state off to the highest bidder since I was in high school 20 years ago.
Earl
@CodeWriter: Well, they’re getting the government they voted (or didn’t vote!) for. Same deal Wisconsin.
Citizen Alan
I live in Mississippi. And I don’t begrudge in the slightest people in blue states who have written this state off and don’t care about what happens to me and my fellow blue Mississippians. We are all best viewed as hostages being held by a hostile power intent on destroying every decent thing about America, and sometimes you just need to shoot the hostage. If the best way to preserve the American Dream is to utterly destroy the red states, I would go to my grave regretting only that I couldn’t do more to help.
Litlebritdifrnt
I went to the Doctors today, on the anniversary of the forming of the NHS. It would appear that I might have had a TIA about 12 days ago. He ordered blood tests, EKG and FULL TIA workup at the hospital. Not going to cost me a penny. I am so grateful for the NHS you have no idea.
Duane
Hi David. Thanks for all the insurance info. It’s a crazy, contorted we have. Ever find out anything about Missouri’s Medicaid “spend down” program. They want 400 a month from me. My SSDI is 1300 a month. Also, fuck John Roberts.
David Anderson
@Duane: this is a pretty good explainer:
http://www.oms.nysed.gov/medicaid/resources/medicaid_spend_down.pdf
And this is a CMS Medicare focused version of Medicaid Spend-down
https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/Downloads/11249-P.pdf
Duane
@David Anderson: Thanks David!