Topeka State officials in Kansas are preparing to ask the federal government for a waiver that would expand the types of services offered under the state's privatized Medicaid program, but the changes could also include work requirements for some Medicaid recipients.
"Kancare 2.0," as officials are calling it, would enable the private health insurance companies that manage people's health care under the program to also act as a primary connection to other kinds of services those people may need such as housing assistance, educational services or job training.
"If someone is homeless, for example, we might be the first state agency they come to and tell us they're homeless," said Kansas Department of Health and Environment Secretary Susan Mosier.
Medicaid would not provide that person with housing assistance, she said, but the worker taking that person's application could put the person in contact with his or her local housing authority, as well as other local services that could help the individual become more self-sufficient.
“The goal for KanCare 2.0 is to help Kansans achieve healthier, more independent lives by providing services and supports for social determinants of health and social determinants of independence in addition to traditional Medicaid benefits," Mosier said.
The new program would emphasize employment as one of those key determinants.
For people with disabilities, KanCare 2.0 would greatly expand a program already in place called Working Healthy, which allows disabled individuals who qualify for Medicaid and who want to work to do so without losing their health benefits.
But for certain able-bodied adults who receive Medicaid because their children qualify for Medicaid, KanCare 2.0 would impose a work requirement.
"We think that’s good for people," said Angela de Rocha, spokeswoman for the Kansas Department for Aging and Disability Services. "It’s good for how they feel about themselves. It’s good for their quality of life. It’s a social determinant of independence, and a social determinant of health. People who are employed are healthier than people who aren’t."
But some health care advocates in Kansas argue that work requirements are both unnecessary and, at least for the time being, not allowed under federal rules.
Suzanne Wikle, a Lawrence resident who works as a senior policy analyst for the Washington-based Center for Law and Social Policy, said the federal government so far has not allowed states to impose work requirements for Medicaid, but she said the Trump administration has signaled that it may be willing to change that policy.
"There have been indications of that, but as of today none have been approved," she said in a telephone interview Friday.
Although work requirements are not yet applicable to Medicaid, they have been applied to other kinds of public assistance programs, and Wikle said they tend not to work out as expected.
"One, they don’t really lead to strong employment outcomes, and certainly not typical employment outcomes that result in health insurance from an employer," she said.
"Also, we know they create a very large bureaucratic red tape system, and that ends up having a negative effect on everyone in the program, not just those that the work requirement is targeted at," she said. "So one side effect is that many people lose Medicaid, not because they become ineligible but because the process becomes more cumbersome to navigate."
De Rocha said the work requirement would apply only to a small segment of the Medicaid population, able-bodied adults with children over the age of 6 who are on Medicaid. It would not apply to the elderly, pregnant women, people in nursing homes or anyone receiving home- and community-based services due to disabilities.
It also would not apply to people who are on Medicaid because they stay home to take care of a person with disabilities.
Because Kansas did not expand its Medicaid program under the Affordable Care Act, only a small number of adults in the state qualify for Medicaid.
According to the state's Medicaid guidelines, a single mother with two children cannot receive Medicaid if her income exceeds $7,644 a year, which is roughly 37 percent of the federal poverty level.
At that level, even a part-time job at minimum wage could disqualify a person from Medicaid.
Children under age 19, however, are eligible for either Medicaid or the state's Children's Health Insurance Program, or CHIP, as long as their family's income does not exceed 244 percent of the poverty level, or $49,020 for a family of three.