Rural Health Policy Project

Proposed Fix to Harmful Medicaid Waivers Impacting Very Poor Parents in Alabama and Mississippi is no Fix at All

Both Alabama and Mississippi have submitted Medicaid Section 1115 waiver proposals that would impose work/community engagement requirements rules on poor parents and caregivers. Because these states have not expanded Medicaid under the Affordable Care Act and have some of them most restrictive eligibility limits in the nation, most people facing loss of health coverage due to these new red tape barriers will be parents and caregivers trying to raise children while living in extreme poverty.

The Alabama waiver would impact parents trying to make ends meet with income of less than $3,740 a year for a family of three or about $312 a month. In Mississippi the waiver would harm parents with incomes of less than $5,610 a year for a family of three or $468 a month.

We have previously released reports about the myriad of harms these proposals would cause in both Alabama and Mississippi. In short, these proposals won’t result in more meaningful employment, as they do nothing to address the myriad of barriers that these mothers face like affordable child care, transportation, job training, et cetera. Women, African-Americans, and families living in rural communities would be disproportionately impacted. As parents lose coverage, children are more likely to become uninsured as well.  

A central issue is that these proposals would create a “Catch-22” situation where a mother trying to meet the new requirement finds herself in a no-win situation – if she complies her income makes her income “too high” to be eligible, and if she doesn’t she loses coverage for non-compliance. Moreover, these parents are a mandatory coverage group. Even CMS Administrator Seema Verma has identified this as a problem – though I am guessing she doesn’t see it as as big a problem as I do…

Now, both states have amended their original proposals and they are open for public comment. Alabama has reopened the state public comment period (close date is August 30) and CMS has reopened the federal public comment period for Mississippi (close date is August 18). While some of the bells and whistles have changed, the only substantive change, which appears to be the answer to the Catch-22 in both states, is an addition of 12 months of Transitional Medical Assistance for those who remain in compliance with the work requirement for every single one of those 12 months. The Center on Budget and Policy Priorities has blogged about why this is a wholly inadequate solution.

A close read of Mississippi’s revised proposal reveals however that even the state itself should recognize that this inadequate and temporary fix is no fix at all. The state’s waiver documents project that only 1,280 parents a year will be able to access the additional TMA coverage for 12 months. This is a mere two percent of parents in Mississippi annually who are receiving Medicaid, according to the state.  

Whether or not CMS approves the revised versions of these proposals remains an open question. I fear that they will. As the court proceedings in the Kentucky litigation have shown, it is extremely important for the public to weigh in on how these proposals will harm residents of these states. In the case of Alabama and Mississippi, it is incumbent on all of us to speak out for the most vulnerable among us as these plans are aimed squarely at families living in extreme poverty.

A one page summary of the revised Mississippi waiver can be downloaded here.

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.