In 2019, for the first time, Indiana’s Medicaid program will require adults to work or volunteer each month to keep their health coverage. Under the Healthy Indiana Plan, the state will take away Medicaid coverage from people who do not report enough work hours, unless they show that they meet certain exemptions. The Trump administration’s Department of Health and Human Services approved Indiana’s plan as part of a nationwide effort to weaken Medicaid coverage. In doing so, it bypassed Congress and overstepped its authority. Similar work requirements have already been struck down by a federal court three separate times in Arkansas and (twice) in Kentucky.
Indiana’s requirement begins in July and will gradually increase to 80 hours per month. How many people could lose coverage? If Arkansas, which briefly put its work requirement into effect, is any indication, the losses will likely be in the tens of thousands. Once Indiana has fully implemented its requirement, it will closely mimic Arkansas’ now-invalidated program. Both projects:
- require 80 hours of work or work-related activities (like volunteering) per month
- apply the work requirement to a broad age range of adults
- require people to report their own hours each month
- end Medicaid coverage for months if a person does not properly report their hours
- provide no additional resources (such as job training or child care) to actually help people find or qualify for a job
While Arkansas’ waiver was approved around the same time as Indiana’s, Arkansas began imposing the work requirements much earlier, and the consequences were drastic. In August 2018, the first month that the new penalties kicked in, the work requirements ended Medicaid coverage for 4,300 people. In the months that followed, thousands more individuals lost their Medicaid coverage. More than 18,000 of Arkansas’ Medicaid enrollees lost their health coverage because they did not report sufficient hours of work or work-related activities last year.
The story of Adrian McGonigal illustrates the destructive nature of the work requirements, even among people who are working. As highlighted in PBS NewsHour, McGonigal had a full-time job and knew he was required to report his hours, but, because the notice the state sent was difficult to understand, he believed that he only needed to verify his work hours once, instead of every month as required. He first realized the state had taken away his health coverage when he tried to fill a prescription and was turned away. No longer able to afford medicine, he became so sick that he was hospitalized and missed so much work that he lost his job – all because of the work requirements.
Work requirements do not work. They don’t make people healthier and don’t lead to long-term employment. And, as seen in Arkansas, rather than promoting work, these requirements add red tape and become barriers to employment. Indiana will fare no better than Arkansas, partly because Indiana has a history of complex rules creating barriers to access Medicaid program, despite its misleading claims to the contrary. For instance, Indiana added a convoluted health expenses account, called a “POWER account,” for all Medicaid expansion enrollees. But a post-implementation evaluation survey showed that 56 percent of HIP members had not heard of POWER accounts or didn’t know they have one. Another 18 percent knew they had an account but never checked it. Overall, that means nearly three of four HIP members did not know or did not use this key “innovation” of the HIP model. Misunderstandings of how the account works were even worse.
Arkansas’ work requirements stripped health coverage from thousands of people in just a few months. Starting in July, the Indiana work requirements kick in. Within months, thousands of Indiana Medicaid beneficiaries could face the same fate as those Arkansans.