Introduction
Oklahoma is planning to ask federal permission to impose a work requirement on very low-income parents and caregivers receiving health coverage through Medicaid. Under the proposal, these beneficiaries would have to document that they are working at least 20 hours a week or participating in job-training or volunteer activities in order to maintain their SoonerCare coverage. The impact of the Oklahoma Health Care Authority’s proposal could mean some of the state’s poorest parents would lose health coverage altogether. And that loss of coverage would affect their children, who may lose coverage, as well.
Oklahoma’s proposal asserts that there will be no impact on Medicaid spending or enrollment if the Centers for Medicare and Medicaid Services (CMS) approve the request to amend the state’s Section 1115 demonstration waiver.[note]P. 15 of OHCA SoonerCare 1115(a) Research and Demonstration Waiver
Amendment Request, accessed on July 10, 2018 at http://okhca.org/xPolicyChange.aspx?id=22257&blogid=68505.[/note] This contradicts assertions made elsewhere in the proposal that the goal is to reduce Medicaid enrollment.[note]See for example p. 14, ibid.[/note] Moreover, it is clear from research based on the experience of work requirements in other programs and other states that significant coverage losses are likely. Nationally, an analysis by the Kaiser Family Foundation found that work rules could cause an estimated 1.4 million to 4 million adults to lose Medicaid coverage. Many of these adults are already working and meet the requirements, but would lose access to health care because of “administrative burdens or red tape.”[note]Garfield, Rachel, Robin Rudowitz and MaryBeth Musumeci. “Implications of a Medicaid Work Requirement: National Estimates of Potential Coverage Losses.” (Washington: Kaiser Family Foundation, June 2018) accessed at https://www.kff.org/medicaid/issue-brief/implications-of- a-medicaid-work-requirement-national-estimates-of-potential-coverage-losses/.[/note] In Arkansas, for instance, 72 percent of the people expected to log into the state’s web portal and report their work did not take action in the first month.[note]Alker, Joan and Maggie Clark, “One Month into Medicaid Work Requirement in Arkansas, Warning Lights are Already Flashing,” (Washington: Center for Children and Families, July
20, 2018) accessed at https://ccf.georgetown.edu/2018/07/20/one-month-into-arkansas- medicaid-work-requirement-the-warning-lights-are-already-flashing/.[/note]