At CCF we have been doing a lot of work lately trying to educate folks about who exactly is impacted by Medicaid waivers that create new barriers to coverage in states that have not accepted the option to expand Medicaid. As our recent reports on Alabama and Mississippi show, these work requirement proposals will result in substantial coverage losses for extremely low-income mothers who are disproportionately African American and/or live in rural areas of these states.

Their children will suffer as well. When parents lose coverage, children become more likely to be uninsured as well and the whole family is affected as mothers are not able to access treatment for conditions such as depression or hypertension. Other states that have been considering this route include Kansas, Oklahoma, South Dakota and South Carolina. (Maine has a proposal pending but I leave it off this list, as Maine should not be in the non-expansion column much longer if the appropriate actions are taken to comply with the voter approved ballot initiative.)

Perhaps the most Orwellian feature of these proposals is that in states with very low parent eligibility levels (parents must have income below 18% of FPL in Alabama, 28% of FPL in Mississippi, and 38% of FPL in Kansas), these parents are caught in a no-win situation. If they comply with the work rule they will earn too much to be eligible for Medicaid and if they don’t meet the work requirement — they also lose coverage. Meanwhile, the chances of their low-wage employers offering them affordable health coverage are very low.

So if you thought these proposals were about “encouraging work” — think again. This Catch-22 belies the reality that these proposals are really about cutting these poor moms off Medicaid. Oh, and by the way, this is a population that states are required to cover under federal Medicaid law.

As we blogged about a while back, Kansas’ pending waiver proposal contains an even more draconian twist—parents who comply with the work requirement can only access Medicaid for 36 months in their lifetime. Governor Colyer has been tussling with the legislature about this for some time and serious concerns have been raised on both sides of the aisle. A few weeks back the Governor said he was willing to give up the time limits component of the request as a concession.

Well this week the legislature stepped in and took some action – passing language as part of their budget package that permits the Governor to negotiate a waiver with CMS but bars implementation until the legislature affirmatively approves it during their 2019 legislative session.

Meanwhile, here in DC, rumors are flying around that the CMS Administrator may actually reject Kansas’ request for time limits. Hmmmm…. maybe that accounts for the goodwill gesture by Governor Colyer.

Various press accounts of CMS Administrator Seema Verma’s comments earlier this week suggest that she is beginning to understand some of the consequences of policy changes such as the Catch 22 situation created for very poor parents by a work requirement. If nothing else, perhaps she is realizing that approving such policy changes would cause CMS serious legal problems.

Editor’s Note: On May 7, CMS Administrator Verma sent a letter to the Acting Medicaid Director to reject Kansas’ request to impose lifetime limits on individuals eligible for Medicaid.