The Journal Record
May 8, 2018
OKLAHOMA CITY – Gov. Mary Fallin signed a bill that puts Oklahoma on track to implementing Medicaid work requirements.
Oklahoma is one of several states that are seeking a waiver that would allow supplemental requirements, and it’s one of few that will request one without first expanding Medicaid. The measure, House Bill 2932, orders the Oklahoma Health Care Authority to work with the federal government to obtain a waiver, which would allow the state to require many recipients to work or volunteer 20 hours a week. Medicaid is a program that uses state and federal money to cover low-income residents’ health care.
That would apply only to able-bodied adults. That excludes children, who make up about two-thirds of the state’s Medicaid users; elderly people; and those with disabilities. There is some debate over how many people this could affect. State Rep. Glen Mulready, R-Tulsa, was the author on the bill. During the bill’s March 6 floor hearing, he said 5,000 people could face losing benefits. The bill’s fiscal impact statement and a press release Fallin’s office issued said it would be about 8,000. Analysts said there could be more or less than that range.
Supporters said the measure is returning the state’s Medicaid program back to its roots, that it was always meant to be temporary and that able-bodied people shouldn’t use it extensively. Critics said the measure would likely be expensive to implement and that removing able-bodied residents’ health insurance is not the most effective way to return them to the workforce.
Mulready, a candidate for Oklahoma insurance commissioner, has said in past interviews and on the floor that Medicaid has never been intended for long-term use, but as a stopgap program for people who wind up in emergencies. When asked how much money the measure could save, Mulready said that if 5,000 people lost eligibility, Oklahoma could save about $25 million, but that isn’t the point.
“Let’s be clear,” he said. “The intent is not to move people out of Medicaid. The intent is to move people to independence out of dependence.”
Fallin’s press release expressed a similar sentiment, that the policy should be used to shape expectations for Oklahoma residents’ role in the workforce.
“It is imperative to provide expectations for all of our citizens who are able to work,” the statement read in part. “Medicaid is meant to be a safety net for the most vulnerable among us: the medically frail, pregnant women, new mothers, and children.”
Several critics inside and outside the Capitol raised a concern about how much money the requirements would cost to implement. The House author argued that there would be no costs involved, and the Legislature’s financial staff did not include costs in their report. However, an analyst noted that the checks required would necessitate more social workers.
“There’s no fiscal impact,” Mulready said during the bill’s floor hearing. “There’s potential if we add a job-training program, but we’re not going to do that.”
Carly Putnam is a health care policy analyst at the Oklahoma Policy Institute, a progressive think tank in Tulsa. She said it’s difficult to comment on the program when there are so many questions yet to be answered. There are still disagreements over how many people this would affect. The bill protects parents with children up to a year old, but it’s unclear whether the state will offer exemptions to people who are taking care of siblings or parents, who account for many of those thousands with no income.
It’s also unclear how much it will cost to increase social worker manpower. Those employees will have to determine whether residents are eligible for exemption. But once that happens, there are ongoing verification requirements. Recipients will continue having to prove their employment or volunteer status and whether they are meeting the 20-hour-week requirement, but it’s unclear how and how often that would be checked.
Kentucky implemented a similar program, Putnam said. It cost about $186 million, likely in technology and increases in the workforce. Although the federal government covered most of that, the state had to pay $20 million.
“Up until this year, knowing if this state could come up with that kind of money was a big question mark,” she said.
Other critics focused on costs, not for social workers, but for immediate health care services.
State Rep. Forrest Bennett, D-Oklahoma City, said the idea is to get people into work, even if it is low income. However, residents making that kind of money would qualify for another state program called Insure Oklahoma. The federal government pays a higher proportion of Medicaid costs than it does for that program.
“This is going to push people into a system that is more expensive for Oklahoma,” he said.
State Rep. Collin Walke, D-Oklahoma City, also raised concerns about cost shifting. He said that if residents can’t access normal health care, they will likely head to hospitals like the University of Oklahoma’s Health Science Center, where emergency rooms are federally mandated to deliver services regardless of the patient’s ability to pay.
“OU and some of our other hospitals will have to eat the costs if we pass this bill,” Walke said.