The Trump administration is encouraging states to impose work requirements on “non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability.” State Medicaid Commissioner Stephanie Azar told lawmakers the agency likely will seek approval for such a requirement this year. SB 140, sponsored by Sen. Arthur Orr, R-Decatur, and HB 331, sponsored by Rep. Arnold Mooney, R-Birmingham, would mandate this policy and place other statutory conditions on Medicaid eligibility. The bill would:

• Require Alabama Medicaid to “request approval of the firmest but nonetheless most reasonable work requirements allowed” by the federal government.
• Require semi-annual, rather than annual, eligibility verification for Medicaid beneficiaries, including a review of financial resources.

Unlike Alabama, most states seeking to impose work requirements have expanded Medicaid to cover low-income working adults. Most of Alabama’s Medicaid beneficiaries are children in low-income families. The next largest groups are people with disabilities, low-income seniors and pregnant women. Only about 75,000 parents and other caretaker relatives of Medicaid children qualify for Medicaid coverage. Nearly 90 percent of them are women. The income limit for Medicaid parents is just 18 percent of the federal poverty level ($307 per month for a family of three).

SB 140 and HB 331 leave many questions unanswered:

• Given Alabama’s stringent Medicaid eligibility for adults, what group or groups will a work requirement target?
• What training and work supports will Alabama offer to help affected beneficiaries find and keep jobs? For example, will the state’s wait-listed program for subsidized child care be expanded?
• Given Alabama’s strong support for children’s health insurance, how will the state mitigate the harm that occurs to children when parents lose coverage?
• How will the work requirement apply to parents who are in school? To those awaiting disability determination? To those who lack reliable transportation? To those who live in areas with high unemployment?
• Is Medicaid equipped and funded to monitor compliance with the new requirements while making sure no individuals eligible for Medicaid fall through the new procedural cracks?
• Since the Affordable Care Act ended asset tests for Medicaid, how does a semi-annual verification of “financial resources” comply?
• If health coverage is a privilege for working people, why hasn’t Alabama expanded Medicaid to cover low-income workers who don’t get employer coverage and can’t afford private plans?

BOTTOM LINE: Creating work requirements and more eligibility hurdles for Alabama Medicaid would erect unreasonable barriers to health care. Making Alabama’s bare-bones Medicaid even more stringent is the wrong way to promote a healthier workforce.