Letters & Testimony

‘Simply cruel’: Testimony from Alabama Arise’s Carol Gundlach against Alabama’s Medicaid work requirements plan

Arise policy analyst Carol Gundlach testified against Alabama’s proposed Medicaid work requirements waiver during a public forum on Monday, March 5, 2018, in Montgomery. Here is the full text of Gundlach’s prepared remarks:

It is important for us to recognize that the people who will be affected by this proposed policy are exclusively the parents or guardians of children, often very young children. Over 90 percent of them are women. They are among the poorest people in Alabama, with an average monthly income of less than $400 for a family of three. These poor families are an extraordinarily vulnerable population to target for the potential loss of health care assistance.

Alabama offers few supports for people transitioning to work. While the waiver request says that people will be referred to supportive services, there is no reason to expect that they will be able to actually receive these services. Subsidized child care, in particular, is a necessity for a parent who works.

In Alabama, however, subsidized child care receives no state funding. As a result, most subsidized child care subsidies serve the highest priority categories, including foster children, children receiving protective services, and children who are in families that receive TANF (Temporary Assistance for Needy Families). In September 2017, there was a waiting list of over 1,000 children and significantly more pent-up need for subsidized day care. The same could be said for other support services, including job training and public transportation, which are essential job supports.

The waiver request says that people who can’t find services like transportation or child care will be exempt. But the way this section is written is particularly confusing and unclear. The waiver request says people “compliant with JOBS are exempt.” And it says that anyone exempt or deferred from JOBS (Job Opportunities and Basic Skills) will not be required to engage in work activities. To be either participating or exempt from JOBS, though, one must be receiving TANF.

There are around 4,000 adults receiving TANF and 75,000 people in the POCR (Parents and Other Caretaker Relatives) Medicaid capacity. While it appears to be implied, the actual language of the waiver request is silent or whether any of the other 71,000 participants not receiving TANF will be deferred if they don’t have child care or transportation.

The waiver request says the Medicaid work program would be “modeled” on the JOBS program. And the proposed memorandum of understanding with DHR (the Department of Human Resources) seems to indicate that non-deferred POCRs will actually be enrolled in the JOBS program or another program administered by DHR that is very similar to JOBS.

A critical element of the JOBS program is access to emergency and job support services, including auto repair, emergency housing assistance, transportation assistance, uniforms and other needs. One of the most important supports in the JOBS program is priority access to subsidized child care without having to be placed on a waiting list.

Will POCR recipients also become eligible for these TANF/JOBS-funded services? And if so, would those auxiliary services by paid for with the already inadequate TANF block grant? If so, this waiver proposes to try to expand services now covering 3,700 people to an estimated additional 17,000 individuals, further stressing an already underfunded JOBS program and reducing assistance now reserved for TANF participants mandated to participate in JOBS.

The waiver request says “every adult in the household” would be required to participate. If this is the case, is the plan to terminate the Medicaid of a compliant or exempt Medicaid recipient if a non-recipient who lives in the same household doesn’t participate? Besides the deep unfairness of punishing the Medicaid recipient for the behavior of another household member, this policy empowers the non-recipient to use the threat of the loss of insurance to abuse and control the Medicaid recipient.

Ultimately, this waiver request raises more questions about what is being proposed than it answers. Most of the answers will apparently be found in the yet unspecified MOUs with the Department of Human Resources and the Department of Labor – MOUs that may not be available to the public before they are implemented.

We need not to overlook that the intent of this proposal is to take health insurance away from targeted women who are unable, for whatever reason, to comply with employment and training activities. The request speaks to the benefits of work for children and families, and we certainly agree that, with the right supports, families are better off when there is earned income.

But I cannot see how the loss of parental health insurance can possibly benefit children. If Mom cannot afford her asthma medicine or her insulin because her Medicaid has been discontinued, then she gets sick and can’t work, or ends up in the hospital, or doesn’t buy the food, clothing or other necessities for her children in order to buy the medicine she needs. Any of these outcomes will hurt the family and the children.

The dignity of work, and the income it produces, does of course benefit families. But to use health care as the stick to force work efforts, without providing the supports that make work attempts successful, is simply cruel and will result in no outcome other than poorer, more desperate and less healthy Alabama families.