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In January 2018, the Centers for Medicare and Medicaid Services issued guidance to state Medicaid directors for how to apply for a waiver to create work requirements for participants to remain eligible for the program. So far, three states (Arkansas, Indiana and Kentucky) have been approved and at least six more states are pending approval to institute work requirements in their Medicaid programs.

This is a major shift in Medicaid, which has functioned as a health coverage program since it began over 50 years ago, to operating more similarly to welfare programs. There are also practical challenges to effectively implementing a work requirement for Medicaid as outlined by CMS.

Implementing a work requirement could be very costly to the state. Proposals currently before the Missouri General Assembly are estimated to have a potential cost to the state of almost $10 million each year.

Seniors, pregnant women and people with disabilities must be exempt from meeting work requirements, but they could still become entangled in bureaucratic red tape while proving they do not have to comply. Missouri’s Medicaid system is already operating with software that is decades out of date and plagued with glitches that incorrectly disenroll participants. A work requirement for Medicaid would create a greater risk that eligible people who have no other health coverage options could be disenrolled due to errors in the system.

The work requirements that have been approved so far are for states that, unlike Missouri, have expanded Medicaid eligibility. Missouri currently has some of the lowest Medicaid eligibility criteria in the U.S. As Missouri restricts childless adults from participating in Medicaid, a work requirement would most directly affect very low-income parents, usually mothers. A work requirement at Missouri’s current eligibility levels would create a catch-22 that for most parents, working 20 hours per week at a minimum wage job would disqualify the participant on the basis of income. A work requirement within Missouri’s current Medicaid system would create a situation where participants would become disqualified from the program for complying with the program requirements.

At Paraquad, our mission is to empower people with disabilities to live as independently as possible with choice and opportunity, and we know that is attained through economic freedom and self-sufficiency. That means work. This is why we advocate for the Ticket to Work Health Assurance Program that allows people with disabilities to work and continue to be eligible for the services that help someone get out of bed and get dressed in the morning, and why we recently opened The Bloom Café where people with disabilities learn job skills and find permanent employment in the community.

Missourians have the ability and desire to work and be successful. Adding a work requirement to Medicaid as proposed does not address the fundamental idea of work as a path out of poverty or improve health outcomes. Current proposals are more likely to exacerbate existing challenges within our current Medicaid program. Organizations within the state are already present at the intersection of work and health care, and know what is needed for people stay healthy and working. There are opportunities to address both issues without adding costly bureaucracy or further jeopardizing the futures of Missourians seeking to rise out of poverty.

Sarah Gentry is the Director of Public Policy and Advocacy at Paraquad. She can be reached at sgentry@paraquad.org.

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