Study shows proposed Medicaid work requirement would disproportionately harm mothers and children

Posted on: 8/8/18

A state proposal requiring Oklahoma parents to find a job or volunteer before receiving Medicaid (SoonerCare) benefits could cause many of the state’s poorest parents to lose health coverage, especially harming Oklahoma mothers and children living in rural areas and small towns, according to a new analysis released yesterday by the Georgetown University Center for Children and Families and the Oklahoma Policy Institute.

The full impact of the proposed rule is unknown because the state has not reported how many beneficiaries will lose coverage or how much money the state will spend or save. Instead, state officials assert that the proposal will have no impact on SoonerCare spending or enrollment, even though the proposal’s goal is to reduce enrollment.

The proposal also does not account for the new IT systems and administrative processes that will be required to implement it – which could be both costly and ineffective at the same time. Without extremely careful implementation, many who are qualified for coverage will lose it because they fail to navigate the additional red tape. Yet the state provides little information as to how these changes will be implemented and how much that will cost.

“This is inconsistent on its face and reflects a disturbing trend among states trying to disguise the effects of limiting access to health coverage,” said Joan Alker, executive director of the Georgetown University center. “The inevitable loss of coverage for parents would also affect their children, creating more financial hardship for families and risking children’s access to health care. Oklahoma already has the fifth highest rate of uninsured children in the country, and that could grow worse.”

The Oklahoma proposal seeks permission from the federal government to amend a Section 1115 demonstration waiver approved last year by the federal Centers for Medicare & Medicaid Services. Essentially, any Oklahoma parents now receiving SoonerCare would have to prove they are working at least 20 hours a week, training for a job, or volunteering.

Because Oklahoma did not expand Medicaid under the Affordable Care Act, the only parents who now qualify for benefits are those living at or below 45 percent of the poverty line. That’s the equivalent of $9,351 a year for a family of three, or $779 a month. An analysis of the parents who would be directly impacted by Oklahoma’s work requirement found that:

• 78 percent are mothers;
• 64 percent are white, 19 percent are African American, and 7 percent are American Indians;
• 39 percent are young parents under age 30;
• 85 percent have been in the workforce or have a family member working sometime in the past six months.

“Most non-elderly adult Medicaid enrollees work, but they have low-wage jobs that don’t offer health insurance. Also, these jobs are often unstable, with frequent job losses and work hours that can fluctuate sharply from month to month,” said Carly Putnam, policy director for the Oklahoma Policy Center. “As a result, many parents would be at risk of losing coverage even when they’re doing everything they can to stay employed.”

Even as this proposal requires SoonerCare patients to report working or lose their health coverage, it provides no resources to help with the barriers that prevent many Oklahomans from having a job. The federal government has made it clear that no new Medicaid funds are available for child care or transportation – two key barriers to low-wage workers. Even if these parents find jobs, the paperwork hassle of reporting and confirming work hours every month is likely to lead them to lose their coverage.

Other families will risk being pushed into the coverage gap caused by Oklahoma’s SoonerCare eligibility cutting off at less than half of the poverty level. And they can’t expect to receive health coverage through their employers. Currently, only 11 percent of Oklahoma residents living in poverty receive employer-sponsored insurance.

The new requirement would hit hardest in Oklahoma’s rural communities and small towns, where families are more likely to rely on Medicaid for their health care than those in urban areas, a study from Georgetown CCF and the University of North Carolina showed. Jobs remain harder to find in these regions. Nine of the 10 Oklahoma counties with the highest unemployment rates in 2017 were rural counties.

To read the study, click here.