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BLOGS

Healthy Michigan Medicaid Work Requirement Bill

11/6/2018

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Category: Public Policy
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State of Michigan Capital Building
The Michigan Medicaid Work Requirement Rule, Senate Bill 897, imposes community engagement activities for non-disabled, Healthy Michigan recipients of the Affordable Care Act (ACA) Medicaid expansion plan, aged 19 – 62, to work or seek employment opportunities a minimum of 80 hours a month to maintain federal insurance benefits, effective January 2020 pending approval by the Center for Medicare & Medicaid Services.
The controversial Medicaid Work Requirement Rule, sponsored by Senator Mike Shirkey (MI-R), representing Branch, Hillsdale, and Jackson counties, passed the Senate (Bill 897) on June 7, 2018 and was signed by Governor Rick Snyder on June 22, 2018.
​
Medicaid work requirement legislation is expected to become law effective January 1, 2020 pending approval by the Center for Medicare and Medicaid Services (CMMS).

The bill originally proposed recipients to work 29 hours per week but was dropped to 80 hours per month (20 hours/week) in order to pass the Michigan House vote.  The effective date of the legislation was also extended from October 2019 to January 2020.

As part of the negotiations and due to racial allegations, work requirement exemptions in counties with unemployment rates at 8.5% or higher was also eliminated.

Some highlights of the final bill signed into law are as follows:
  • Non-disabled, Healthy Michigan recipients, aged 19 – 62 will be required to work 80 hours per month to retain Medicaid health insurance benefits.
  • Households earning between 100 – 133% of the federal poverty level will continue eligibility for Medicaid.
  • Persons affected by the work requirement rule will be given a ninety (90) day grace period of non-compliance in the first year and to allow for seasonal work.
  • Non-disabled recipients will be restricted to a 48-month (4 year) lifetime limit.

Please review the link to SB 897 for a complete list of requirements and exemptions.

The goal of proponents for legislative changes to the Michigan Medicaid bill claim that it will restore dignity and self-sufficiency, improve health outcomes, close gaps in labor supply, and save taxpayers money by moving able-bodied, working-age people off federal insurance rolls.
​
The basic logic of Medicaid work requirements has four components:
  1. Welfare programs is a viable source of “skilled” workers.
  2. Welfare programs does little, if anything, to ease poverty.
  3. Welfare programs fail to promote work and self-sufficiency.
  4. Work is the best way to escape poverty.

Local Workforce: Supply and Demand
The Trump administration persists in taking credit for the flourishing economy and maintains that its policies incentivizes low-income Americans to return to the labor force while providing qualified workers to employers who will continue to grow the economy.

However, a recent analysis, published in the LinkedIn Workforce Report (October 2018) shows a 1.6% drop in hiring rates in Detroit due to a skills gap and migration patterns in the region.  Data is based on trends from September 2017 through September 2018.

That is, employers are not finding qualified workers because more unskilled workers are moving in and those likely possessing the needed skills are moving out.

The report tracks U.S. workforce hiring trends derived from comparison data of job postings and member profiles posted on LinkedIn.  It is a valuable resource for those seeking employment opportunities throughout the country, especially in large Metropolitan cities.

Data provided in the LinkedIn report provides information on surplus skills (supply) in the area and skill shortages (demand) needed by employers.  As well, we can identify the number of workers moving in and out of the area, where their migrating from, where they are migrating to, and how this factor impacts the local job market.

A link is provided below to the LinkedIn report.

Approval of State Waivers for Medicaid Work Requirements
On January 11, 2018, the U.S. Centers for Medicare & Medicaid Services (CMS) announced its approval of new guidance policies in support of state initiatives to implement community engagement activities for non-disabled, working age beneficiaries of Medicaid.

Community engagement activities, that is, work requirements to include employment, skills training, education, job search, volunteer work, or caregiving is intended to help states develop demonstration projects.

According to CMS, state-level program designs should also promote the objectives of Medicaid guidelines within the confines of federal statutory requirements.  That is, to promote better physical and mental health without violating federal regulations of the Medicaid program.

​Medicaid Enrollment and Costs in Michigan

According to the Michigan Department of Health and Human Services (MDHHS), there were 1,858,112 Medicaid cases in FY17 from October 2016 to September 2017, through which 2,920,176 total individual recipients received health insurance benefits.

MDHHS reported a total of 1,767,618 Medicaid recipients in FY15 after the Obamacare expansion became effective 4/1/14.

Of the nearly 3 million people across 83 counties in Michigan who received Medicaid benefits in FY17, an estimated 700,000 gained coverage through ACA’s expansion provision.

The annual expense for Medicaid in the State of Michigan is an estimated $16 billion in healthcare coverage.

Medicaid benefits are provided in six (6) broad categories:
  • Families                                                                         
  • Children, under 21                                                        
  • Pregnant Women & Children under 19                        
  • Michigan MI Child Recipients                                     
  • SSI Recipients (Aged, Blind & Disabled)
  • Non-SSI Recipients (Aged, Blind & Disabled)
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According to the Kaiser Family Foundation (2016), 27% of Michigan’s population (9.9 million) are low-income with 21% receiving health benefits under Medicaid programs.

​The Kaiser Foundation study reports 70% of Medicaid enrollees are adults and children expending 30% of the costs; while 22% are elderly and disabled accounting for 62% of all funding expenditures.

​
*The following table is an overview of Michigan Medicaid recipients per county (FY17).
County
Total Medicaid Cases
Total Medicaid Recipients
Population
% of Population on Medicaid
Unemployment
Rate
(Current - May 2018)
Alcona
2279
3420
10,312
33%
6%
Alger
1505
2356
9121
26%
8%
Allegan
17,669
30,547
116,447
26%
3%
Alpena
6913
10,250
28,462
36%
5%
Antrim
4412
7253
23,292
31%
6%
Arenac
3637
5610
15,045
37%
6%
Baraga
1668
2646
8441
31%
7%
Barry
8499
14,125
60,586
23%
3%
Bay
21,619
32,689
104,239
31%
5%
Benzie
3320
5308
17,573
30%
5%
​Berrien
32,662
52,388
154,259
34%
4%
Branch
8592
14,992
43,410
35%
4%
Calhoun
31,930
50,038
134,128
37%
4%
Cass
9410
15,603
51,381
30%
4%
Charlevoix
4333
6999
26,139
27%
5%
Cheboygan
5844
9227
25,369
36%
5%
Chippewa
6661
10,245
37,711
27%
7%
Clare
8634
13,257
30,653
43%
6$
Clinton
8528
13,907
78,443
18%
3%
Crawford
3434
5315
13,907
38%
6%
Delta
7325
11,262
35,965
31%
6%
Dickinson
4544
7056
25,415
28%
4%
Eaton
16,339
26,098
109,027
24%
3%
Emmet
5773
8941
33,193
27%
6%
Genessee
107,345
162,927
407,385
40%
5%
Gladwin
5744
8721
25,234
35%
5%
Gogebic
3520
5316
15,342
35%
6%
​Grand Traverse
14,732
22,777
91,807
25%
4%
Gratiot
8109
13,222
41,018
32%
4%
Hillsdale
8929
15,189
45,879
33%
4%
Houghton
5888
9898
36,305
27%
6%
Huron
5552
8854
31,280
28%
5%
Ingham
57,573
89,365
290,186
31%
4%
Ionia
10,499
17,655
64,291
27%
3%
Iosco
6512
9887
25,162
39%
6%
Iron
2617
3988
11,124
36%
6%
Isabella
11,840
17,857
71,063
25%
4%
Jackson
33,404
51,015
158,640
32%
4%
Kalamazoo
48,524
73,310
262,985
28%
8%
Kalkaska
4248
7047
17,634
40%
5%
Kent
113,023
183,635
648,594
28%
3%
Keweenaw
358
592
2105
28%
8%
Lake
3634
5432
12,013
45%
7%
Lapeer
13,660
23,190
88,174
26%
4%
Leelanau
2358
3886
21,657
18%
4%
Lenawee
16,555
27,389
98,623
28%
4%
Livingston
17,306
27,142
189,651
14%
3%
Luce
1382
2157
6358
34%
7%
Mackinac
1939
2905
10,712
27%
5%
Macomb
151,614
241,510
871,375
28%
4%
Manistee
5102
7944
24,427
33%​
6%
Marquette
11,180
16,631
66,502
25%
5%
Mason
6108
9748
29,073
34%
4%
Mecosta
8787
13,522
43,391
31%
5%
Menominee
4008
6334
23,046
28%
4%
Midland
13,213
20,984
83,411
25%
4%
Missaukee
3207
5444
14,998
36%
5%
Monroe
22,348
35,515
149,649
24%
4%
Montcalm
​13,249
22,019
63,550
35%
4%
Montmorency
2143
3270
9250
35%
8%
Muskegon
43,187
67,286
173,693
39%
5%
​Newaygo
10,965
18,345
48,242
38%
4%
Oakland
160,191
242,393
1,251,000
19%
3%
Oceana
6246
11,573
26,442
24%
6%
Ogemaw
5673
8775
20,981
42%
7%
Ontonagon
1208
1745
5881
30%
9%
Osceola
5612
9104
23,260
39%
4%
Oscoda
2226
3438
8287
41%
6%
Otsego
5651
9224
24,538
38%
5%
Ottawa
29,178
49,684
286,383
17%
3%
Presque Isle
2593
3927
12,791
31%
7%
Roscommon
6153
9440
23,895
40%
7%
Saginaw
46,957
70,539
191,934
37%
5%
Sanilac
7967
13,093
41,269
32%
5%
Schoolcraft
1835
2808
8049
35%
7%
Shiawassee
13,027
21,144
68,446
31%
4%
St. Clair
30,652
48,195
159,350
30%
4%
St. Joseph
12,808
22,066
60,947
36%
3%
Tuscola
11,193
18,304
52,764
35%
6%
Van Buren
17,129
29,408
75,353
39%
5%
Washtenaw
47,651
71,044
367,627
19%
3%
Wayne
510,461
802,760
1,754,000
46%
5%
Wexford
​8510
13,948
33,276
42%
5%
Source: Total Eligible Medicaid Case and Recipient Annual Information, FY17 - Michigan Department of Health and Human Services (MDHHS)
Exemptions and Who Will Be Affected
The Medicaid work requirement rule will generally apply to able-bodied adults and particularly those on the Healthy Michigan plan added through Obamacare.

There are twelve (12) categories of exemptions for Medicaid recipients as follows:
  • Children (under age 19)
  • Seniors (aged 62 and over)
  • Disabled or medically-frail (including the blind)
  • Persons with work limitations (medical documentation required)
  • Pregnant women
  • Caregivers of young children under age 6 or a family member who is pregnant or disabled (receiving long-term disability benefits)
  • Full-time students
  • Recipients of state unemployment benefits (UI)
  • Recipients of SNAP benefits (FAP) who are already exempt
  • Foster care children (aged 20 and under)
  • Persons who meet “good cause” temporary exemptions (unspecified)
  • Returning citizens (who were incarcerated in the recent 6 months)
  • Persons receiving substance abuse treatment

Medicaid Work Requirements and In-Work Poverty
When we look at the work requirement rule we must consider how and why employed workers may still lose their benefits.

We have already established that most Medicaid recipients already work.  However, since they are mostly uncounted in the labor force and in welfare budgets, there is no real way to know how often they work (e.g. seasonal, temporary) and how many hours (e.g. part-time, full-time).
But, just to give us an idea.

According to the Bureau of Labor Statistics (2018), there were 4,909,907 jobs in Michigan as of July 2018, of which 4,697,925 were filled (that is, 4,697,925 people were employed).  Only 211,982 people were unemployed at a rate of 4.3% of the Michigan population.

Of course, this does not account for concentrated pockets of poverty and unemployment in certain counties and cities in the state.  Still, it does substantiate the point that most Medicaid recipients in the area are currently employed but remain in jeopardy of losing their health benefits.

One reason that employed Medicaid recipients may lose their health insurance coverage due to the new work requirement rule is that many are low-skilled workers with temporary and part-time employment.  Others may be skilled tradesman but are still affected due to seasonal work.  This is problematic for claims that there is an untapped reserve of millions of qualified workers among low-income Americans on welfare who are needed to fill gaps in the labor force and continue to grow the economy.

According to the U.S. Census Bureau’s Survey of Income and Program Participation Report (SIPP, 2012), the largest proportion (33.5%) of participants in means-tested (welfare) programs were unemployed workers.  That is, unemployed workers are likely those receiving Unemployment Insurance (UI) benefits.

However, another 25.3% of the unemployed discouraged workers (those not participating in the labor force at all) participated in major welfare programs including Medicaid and the Supplemental Nutrition Assistance Program (SNAP).  Another 17.6% of part-time workers and 6.7% of full-time workers received welfare benefits.

But, those are the national numbers.

Here in Michigan, if we consider the MDHHS Annual Caseload Report (Table 1), we can see that county unemployment rates throughout the state run no higher than 9%, yet most of those counties present, at minimal, almost one (1) quarter to nearly half of their population as receiving Medicaid and other welfare benefits.

That is, again, the majority of participants in the Medicaid program already work but continue to live in poverty, lack employer-sponsored health coverage, and so on.  This is what we refer to as in-work poverty.

Medicaid Recipients in Michigan
According the Michigan Department of Health and Human Services (MDHHS), as of September FY2017 with a population of 9.962 million, there were 2,920,176 million recipients of Medicaid.  The U.S. Census Bureau reports the population statistics of Wayne County as of July 2017 at 1.753,616 with almost 46% receiving Medicaid benefits (see the MDHHS report). 

The poverty rate in Wayne County was 22.9% with unemployment at 6.3% during this same period, by the way.

Do we need any more proof that most people on Medicaid are already employed?

It should be noted that each Medicaid case and recipient was counted as receiving benefits at least once during the fiscal year (2017) and does not specify the length of time they were on Medicaid nor any other form of assistance received.

As such, in the numbers of Michigan Medicaid enrollees, the MDHHS report does not indicate how many recipients were employed and, if employed, were they working full or part-time, temporary or seasonal.  But the Bureau of Labor Statistics reported a 4.3% unemployment rate in the region during the same period.

So, it is safe to say that most Medicaid recipients have jobs.  That means, not only are employed Medicaid enrollees receiving federal health insurance benefits, they are also paying taxes.

Then, the question is how much in purported tax savings is there for non-Medicaid workers?

Still, some complain that the Healthy Michigan plan, targeted to low-income workers or the “working poor” through the Obamacare expansion in 2014 is unsustainable and needs to be reformed.  According to the Michigan Chamber of Commerce, the Healthy Michigan program is over-enrolled and underfunded (Detroit Free Press, April 2018).

But, we’ll save the discussion on how and how much Medicaid is funded for a later date.

Michigan Senate Bill 897 – Medicaid Work Requirement Rule
In the final draft of Senate Bill 897 which proposed changes to the Medicaid program in effect established new eligibility criteria.

In order to continue eligibility for Medicaid benefits recipients will be required to:
  • Complete 80 hours (20 hours/wk.) of qualifying community engagement activities (e.g. work, school, or volunteering)
  • Report their family income monthly.
  • Report changes to family income within ten (10) days.
  • Recipients failing to meet work requirements in a month will be given a warning and thirty (30) days to become compliant or lose their Medicaid benefits for one (1) year.

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Contact Us:
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Related Posts:
State Assistance Programs Enforce Work Requirements for Government Benefits
http://www.canmichigan.com/blog/state-assistance-programs-enforce-work-requirements-for-government-benefits
[Opinion] – The Working Poor: On Welfare with A Job
http://www.canmichigan.com/blog/opinion-the-working-poor-on-welfare-with-a-job
Poverty & Welfare, Human Behavior, and the Trump Election
http://www.canmichigan.com/blog/poverty-welfare-human-behavior-and-the-trump-election

​Links:
Healthy Michigan Plan Work Requirements and Premium Payment Requirements (SB 897)
http://www.legislature.mi.gov/documents/2017-2018/billanalysis/House/htm/2017-HLA-0897-78EF78F9.htm
LinkedIn Workforce Report – Detroit, October 2018
https://www.linkedin.com/jobs/blog/linkedin-workforce-report-october-2018-detroit-mi  
MDHHS Total Eligible Medicaid Cases and Recipients (FY2017)
https://www.michigan.gov/documents/mdhhs/GA-003-Annual_Medicaid_Cases_Recipients_513891_7.pdf  
U.S. Department of Labor – Bureau of Labor Statistics Databases, Tables & Calculations
https://data.bls.gov/timeseries/LASST260000000000003
U.S. Department of Labor – Bureau of Labor Statistics, Midwest Information Office, Michigan
https://www.bls.gov/regions/midwest/michigan.htm   
U.S. Census Bureau Quick Facts – Wayne County, Michigan
https://www.census.gov/quickfacts/fact/table/waynecountymichigan/PST045217
 
Articles:
Have Medicaid? New Michigan Bill May Force You to Work (April 2018)
https://www.freep.com/story/news/2018/04/18/michigan-medicaid-work/528197002/
Confused About Michigan Medicaid Reform? These Maps and Charts Explain It All (May ’18)
https://www.bridgemi.com/public-sector/confused-about-michigan-medicaid-reform-these-maps-and-charts-explain-all
Snyder: Deal on Medicaid Work Rules is ‘Basically There’ (June 2018)
https://www.freep.com/story/news/politics/2018/05/31/michigan-medicaid-work-rules/660980002/
Michigan and the ACA’s Medicaid Expansion (June 2018)
https://www.healthinsurance.org/michigan-medicaid/
Snyder Signs 80 Hour Medicaid Work Requirement Law
https://www.detroitnews.com/story/news/local/michigan/2018/06/22/michigan-medicaid-work-requirement-law/726538002/
Michigan Bill Forces Medicaid Recipients to Work 80 Hours Per Month (June 2018)
https://www.freep.com/story/news/2018/06/07/michigan-medicaid-employment-jobs-snyder/681138002/
Welfare Work Requirements Will Ease Poverty and Improve Our Workforce (July 2018)
https://www.usatoday.com/story/opinion/2018/07/25/welfare-work-programs-help-people-escape-poverty-column/806311002/
Some on Medicaid Must Adopt A ‘Healthy Behavior’ or Lose Coverage
http://www.crainsdetroit.com/article/20171022/news/642706/some-on-medicaid-must-adopt-a-healthy-behavior-or-lose-coverage
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    Deborah Mitchell

    Welcome to The Community Advocate Network.  My name is Deborah Mitchell,  I am a graduate in Social Work and Registered Social Work Technician.  My human service background began in 2007 which includes medical case management and service navigation for the indigent population, outpatient mental health counseling with substance use and abuse disorders, supportive employment and job development for mental health consumers, and structured living domicile management.

    In 2016, I completed my Bachelors Degree in Social Work and began my graduate studies at Wayne State University in Detroit, Michigan.

    On this platform we will be reviewing social topics and news and providing resources to community programs and services.  It is my goal to maintain a recovery-focused, service-oriented environment while working to expand the capacities of individuals, families, groups, organizations, and communities in developing and restoring optimal social and economic functioning.

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