Work requirement for Medicaid enrollees is reasonable expectation

Throughout Montana, the question is the same this summer: Where have all the workers gone?

As so many businesses are now hamstrung by hiring woes, it raises eyebrows and perhaps some ire that federal health officials are poised to reject Montana’s request to include work requirements for beneficiaries of its Medicaid expansion program.

Medicaid provides health insurance to more than 100,000 low-income adults, and the Trump administration urged states to show proof that adults enrolled in the program were either working some hours or looking for work as a condition of receiving Medicaid expansion benefits. That requirement reflects the core belief of many Montanans, that while Medicaid is a safety net for low-income people, it shouldn’t be a gravy train.

Now, under President Joe Biden, the Centers for Medicare and Medicaid Services has switched gears, and told state health officials that a five-year extension of the Medicaid expansion waiver will not include work or community engagement requirements.

The state’s Democratic leaders assert that seven in 10 Montanans who got Medicaid coverage under the expanded program already have jobs, and the rest are either caregivers, students or have an illness. Perhaps that’s a valid argument; perhaps not. We all know human nature is a factor, and there is no doubt a certain percentage of Medicaid recipients who will do whatever it takes to not find a job.

Let’s not forget that it took bipartisan support in the Montana Legislature — a rarity these days — to pass Medicaid expansion in the first place. Two years ago moderate Republicans joined Democrats in voting to extend the 2015 program as long as it included work requirements. Montana’s Medicaid expansion program will end in 2025 if the Legislature doesn’t renew it. And, as the state house leans ever more conservative, we can kiss Medicaid expansion good-bye if the feds strip away the work requirement.

According to a recent Kaiser Health News story, Montana’s official position is that it wants “to condition Medicaid coverage on compliance with work/community engagement requirements.” No other alternative has yet been proposed. What have been proposed by Republican lawmakers and Gov. Gianforte are measures aimed at trimming the number of Medicaid expansion enrollees, increasing the premiums some enrollees pay and ending a provision that allows 12 months of continuous eligibility regardless of changes in income.

Tightening up the state’s Medicaid expansion requirements and thereby perhaps getting a few more people into the workforce won’t solve business’ staffing crises, but it’s a step toward making sure every able-bodied Montana can contribute, whatever the job may be.