Mississippi’s request for a Medicaid work requirement has emerged as the one to watch. Its section 1115 waiver is now awaiting federal action and could well be the test of whether states that have never accepted the Medicaid expansion can impose this sort of requirement on their most vulnerable parents.
CCF, working with the Mississippi Health Advocacy Program and the Mississippi Center for Justice, released a report this week detailing what the state is trying to do and who will be affected.
Mississippi’s proposal would require 20 hours a week of work or community service for parents with incomes at or below 27% of FPL—these are families whose income is no more than $468 a month for a family of three.
Who are these families? Our analysis found that the vast majority are women head of households (91 percent), more likely to be African-American (71 percent) and more likely to live in rural areas and small towns. About half of these parents (49 percent) are not in the workforce because they are caring for a child or someone with a disability. Only one third describe themselves as unemployed.
Children will also be harmed if parents lose coverage. Research is clear that being uninsured raises the risk for parents and children to not be able to access the health services they need.
The proposal includes some poorly defined exemptions such as “being a primary caregiver for a person who cannot care for himself or herself.” It is not clear what this means with respect to children and which parents are exempt. Further, the proposal exempts persons receiving treatment for cancer but not persons receiving treatment for other serious conditions such as cardiovascular disease or diabetes.
The state argues that the proposal is an opportunity to “increase participant’s ability to obtain and maintain employment and employer-sponsored health care, slow down the rising costs of health care spending, and familiarize individuals with private health insurance practices.”
However, I believe the proposal will not accomplish any of these objectives but will result in thousands of parents (5,000 in the first year alone according to the state’s own numbers) losing their Medicaid and most likely becoming uninsured. The state has requested federal Medicaid match for job training activities but the Trump Administration’s guidance on this issue has been clear that federal Medicaid match is not available. Moreover, nothing in the proposal will address the high rate of unemployment in many counties in Mississippi.
Finally, an examination of the public comments submitted to the federal government shows that not a single one in support of the Mississippi waiver request was filed. Meanwhile, a diverse group of organizations – including the American College of Physicians, the American Heart Association, the American Diabetes Association, the American Academy of Pediatrics, the Children’s Defense Fund – submitted comments opposing the Mississippi proposal stating that it would be harmful to these very poorest families in Mississippi.
