Work Requirements May Change Medicaid  05/23 06:18

   

   (AP) -- The U.S. social safety net would be jolted if the budget bill backed 
by President Donald Trump and passed Thursday by the House of Representatives 
becomes law.

   It would impose work requirements for low-income adults to receive Medicaid 
health insurance and increase them for food assistance as well as cut funding 
for services like birth control to the nation's biggest abortion provider.

   Supporters of the bill say the moves will save money, root out waste and 
encourage personal responsibility.

   A preliminary estimate from the nonpartisan Congressional Budget Office said 
the proposals would reduce the number of people with health care by 8.6 million 
over a decade.

   The measure, which also includes tax cuts, passed the House by one vote and 
could have provisions reworked again as it heads to the Senate.

   Here's a look at the potential impact.

   Work would be required for most people to get Medicaid health insurance

   Starting next year, many able-bodied Medicaid enrollees under 65 would be 
required to show that they work, volunteer or go to school in exchange for the 
health insurance coverage.

   Some people who receive Medicaid were worried Thursday that they could see 
their coverage end, even if it is not immediately clear whether they might be 
covered by an exception.

   Raquel Vasquez, a former cook who is battling two types of cancer and has 
diabetes, said she believes she could be affected because she has not been able 
to qualify for Social Security disability benefits. "I cannot even afford this 
life now because of my disabilities," said the 41-year-old Bakersfield, 
California, resident. "But my country won't even help me."

   About 92% of people enrolled in Medicaid are already working, caregiving, 
attending school or disabled. That leaves about 8% of 71 million adult 
enrollees who would need to meet the new requirement. An estimated 5 million 
people are likely to lose coverage altogether, according to previous estimates 
of the bill from the Congressional Budget Office.

   Only Arkansas has had a work requirement that kicks people off for 
noncompliance. More than 18,000 lost coverage after it kicked in 2018, and the 
program was later blocked by federal courts.

   "The people of Arkansas are generous and we want to help those who cannot 
help themselves, but we have no interest in helping those who are unwilling to 
help themselves," said Arkansas Senate President Pro Tempore Bart Hester, a 
Republican. "I'm glad the federal government is starting to align with our 
thinking."

   Work requirement could hit harder in rural areas

   Increased eligibility checks and red tape related to work requirements may 
result in some people wrongly getting booted off, said Eduardo Conrado, the 
president of Ascension, a health care system that operates hospitals across 10 
states.

   That could spell trouble for rural hospitals, in particular, who will see 
their small pool of patients go from paying for their emergency care with 
Medicaid coverage to not paying anything at all. Hospitals could have to eat 
their costs.

   "Adding work requirements is not just a policy change, it's a shift away 
from the purpose of the program," Conrado said of the rule.

   That is also a concern for Sandy Heller, of Marion, Massachusetts.

   Her 37-year-old son, Craig, has Down syndrome and other complicated medical 
needs.

   She worries the changes would make it harder for hospitals in out-of-the-way 
places like hers to stay afloat and offer the services he could need.

   If they don't, he would have to travel about 90 minutes for care.

   "It could mean life and death for my son if he needed that medical care," 
Heller said.

   More people would be required to have jobs to receive food assistance

   The Supplemental Nutrition Assistance Program, formerly known as food 
stamps, already requires work for some of its roughly 42 million recipients. 
Adults ages 18-54 who are physically and mentally able and don't have 
dependents must work, volunteer or participate in training programs for at 
least 80 hours a month, or else be limited to just three months of benefits in 
a three-year period.

   The legislation passed by the House would raise the work requirement to age 
65 and also extend it to parents without children younger than age 7. The bill 
also would limit the ability to waive work requirements in areas with high 
unemployment rates.

   The combination of those changes could put 6 million adults at risk of 
losing SNAP benefits, according to the liberal-leaning Center on Budget and 
Policy Priorities.

   Like work requirements for Medicaid, those for SNAP tend to cause a decrease 
in participation without increasing employment, according to an April report by 
the Brookings Institution's Hamilton Project.

   States that cover immigrants lacking legal status would lose federal funds

   Under the bill, the federal government would punish states that use their 
own state dollars to provide Medicaid-covered services to immigrants lacking 
legal status or to provide subsidies to help them buy health insurance.

   Some states that provide that sort of coverage extend it only to children.

   Those states would see federal funding for the Medicaid expansion population 
-- typically low-income adults -- drop from 90% to 80%.

   That could mean states pull back that Medicaid coverage to avoid the federal 
penalty, said Joan Alker, executive director of Georgetown University's Center 
for Children and Families.

   KFF said the provision could affect 14 states that cover children regardless 
of their immigration status.

   This month the Democratic governor of one of them -- California's Gavin 
Newsom -- announced a plan to freeze new enrollments of adults in state-funded 
health care for immigrants who do not have legal status as a budget-balancing 
measure.

   The bill could curtail abortion access by barring money for Planned 
Parenthood

   Planned Parenthood says a provision barring it from receiving Medicaid funds 
could lead to about one-third of its health centers closing.

   The group said about 200 centers are at risk -- most of them in states where 
abortion is legal. In those states, the number of Planned Parenthood centers 
could be cut in half.

   Planned Parenthood, the nation's largest abortion provider, also offers 
other health services, including birth control and cancer screening.

   Federal money was already barred from paying for abortion, but state 
Medicaid funds in some states now cover it.

   "We're in a fight for survival -- not just for Planned Parenthood, but for 
the ability of everyone to get high-quality, non-judgmental health care," 
Planned Parenthood President and CEO Alexis McGill Johnson said in a statement.

   Susan B. Anthony Pro-Life America celebrated the provision, saying "Congress 
took a big step toward stopping taxpayer funding of the Big Abortion industry."

   Health services for transgender people would be cut

   Medicaid would stop covering gender-affirming care for people of all ages in 
2027 under one provision.

   Further, coverage of the treatments could not be required on insurance plans 
sold through the exchanges under the Affordable Care Act.

   Trump has targeted transgender people, who make up around 1% of the U.S. 
population, since returning to office, including declaring that the U.S. won't 
spend taxpayer money on gender-affirming medical care for transgender people 
under 19. The care includes puberty blockers, hormone therapy and surgeries.

   The bill would expand that to all ages, at least when it comes to Medicaid.

   Some states already block the coverage, and some require it. It's unclear 
how much Medicaid has spent on providing gender-affirming care, which has only 
been recently added to some coverage plans in some states.