About 350,000 San Diego County residents would be affected by work requirements proposed in federal budget revisions debated in Washington this week.
The House Committee on Energy and Commerce approved its piece of the larger spending package Wednesday, but only after a marathon discussion, a significant part of which focused on language that would impose work requirements on Medicaid beneficiaries ages 19 to 64 who qualified for coverage through the Affordable Care Act’s expansion of the program in 2014. The ACA extended the last-resort health insurance program to all adults younger than age 65 and making no more than 138% of the federal poverty rate.
Previously, Medicaid, called Medi-Cal in California, only covered adults with disabilities or minor children.
One of several Medicaid-modifying changes in the budget bill would require adults who qualified for their coverage through ACA expansion to prove that they have at least 80 hours of “community engagement” per month while receiving benefits. The bill defines engagement as work, community service, educational program enrollment or a combination of those categories.
Exemptions to this requirement would be granted for pregnancy, medical frailty, status as an American Indian, guardianship of a disabled individual or dependent child, substance use disorder, physical, intellectual or developmental disability or “complex” medical conditions. Inmates and those participating in substance use treatment programs would also be exempt from the engagement requirement.
The proposed requirements would not take effect until Jan. 1, 2029, meaning they would not be in play until after the nation undergoes both a midterm and presidential election, though there is talk in Washington that some Republicans are pushing for an accelerated implementation.
San Diego County’s Department of Self-Sufficiency Services oversees local enrollment and annual eligibility re-verification for Medi-Cal and other government programs for local residents. Rick Wanne, the department’s director, said Friday that 354,207 current Medi-Cal beneficiaries living in San Diego County qualified for coverage under Medi-Cal expansion, putting them in the crosshairs of work requirement amendments if budget bills are ultimately approved by Congress and ratified by the Senate.
The number makes up roughly one-third of the county’s 1.1 million Medi-Cal enrollees.
The Republican proposals to modify Medicaid also call for penalties against states that spend their own money to extend coverage of undocumented immigrants. California is among 14 states nationwide that have taken this step in recent years and the county’s eligibility system lists 65,687 residents with undocumented immigration status who have applied for and received Medi-Cal coverage.
Wednesday’s budget hearing had many representatives estimating that millions will end up losing coverage due to the proposed work requirements which, they pointed out, have resulted in significant coverage erosion when similar programs were attempted in several states.
Rep. Scott Peters is San Diego’s lone representative on the energy and commerce committee, and he proposed an amendment during the hearing this week to remove the work requirements section from the reconciliation bill.
“We look at Arkansas; when the state piloted its Medicaid work requirement, over 18,000 people lost coverage, not because they refused to work, but because they struggled to report their hours in a newly created online-only portal,” Peters said. “The vast majority of these people had jobs, many were caring for disabled relatives, recovering from illness or navigating mental health challenges.
“(The) problem is, the work requirements didn’t for all that. Local doctors and clinics felt the strain almost immediately. Patients missed their follow-up appointments, emergency rooms saw increases in uncompensated care.”
Similar experiments in Georgia and New Hampshire, Peters said, had similar results.
But committee chair Brett Guthrie, R-Kentucky, said that the experiences of these states would not hold for the national attempt at tying Medicaid to work ability.
“We have crafted this bill carefully to avoid the issues that they have,” Guthrie said. “We absolutely don’t want people who qualify for Medicaid to not receive Medicaid because of red tape, particularly when they’re trying to work and be gainfully employed.”
Ultimately, Peters’ proposed amendment failed to gain enough . The markup bill ed on a 30-24 vote.
Also included in the legislation is a requirement that states re- Medicaid eligibility for adults enrolled under ACA expansion once every 12 months in order to make sure that beneficiaries still meet the income or disability guidelines that originally qualified them for coverage. The bill would require such reviews every six months for expansion enrollees, a requirement that would add significant work to the county’s verification workers. According to a county representative, 658 workers conduct annual eligibility reviews for social programs. Today, Medi-Cal reviews represent about 66% of their total workload.
