Ohio medical professionals are concerned about proposed Medicaid work requirements, fearing that if implemented, they will create barriers to care for patients in greatest need, according to emails obtained and interviews conducted by the Ohio Capital Journal.
Ohio’s 2023 budget requires the state Medicaid department to reapply to the federal government under the Trump administration for permission to impose work, drug testing, or education requirements on adult Medicaid recipients.
The Ohio Department of Medicaid’s proposal would require adults under the age of 55 to demonstrate that they worked at least 20 hours per week in order to qualify for Medicaid, unless an exception exists, such as school enrolment or intensive physical care needs.
Hundreds of Ohioans have filed comments with the Ohio Department of Medicaid opposing the move.
During Trump’s first administration, more than a dozen states approved Medicaid work requirements.
Two states, Georgia and Arkansas, are currently in the process of reducing the requirements due to unexpected costs and administrative burdens.
According to the Kaiser Family Foundation, more than 90% of U.S. adults eligible for Medicaid expansion are already working or may be exempt from the requirements.
In a statement on the proposal released on December 17, Ohio Governor Mike DeWine stated that his goal is to empower all people to reach their full potential.
“While this certainly includes providing critical assistance to people when they need it, we also have a responsibility to ensure as many Ohioans as possible are on a pathway to financial independence,” the governor said.
According to the Ohio Department of Medicaid, the new rules would prevent at least 61,826 Ohioans from receiving Medicaid.
However, according to research from the Centre for Community Solutions, a Cleveland-based health policy think tank, 450,000 Ohioans could lose health insurance if the work requirement is implemented.
According to the centre, Pike County has the highest percentage of the working-age population who are at risk (15.9%). Scioto County follows closely behind with 15.2%. According to the center’s research, eleven other counties have a rate of more than 10%.
Comments from medical professionals to the Ohio Department of Medicaid
Several doctors, nurses, and clinicians were among the hundreds of people who submitted comments to the Medicaid department opposing the plan, discussing how it would affect the health of all Ohioans.
“I work with Medicaid patients, many of whom are unable to work due to physical or mental health issues,” wrote Alex Fay, a registered nurse in Cleveland, on Jan. 16. “Who will determine what constitutes working or looking for work, and who is too sick or ill to work? Will patients who are homeless or experiencing domestic violence be expected to work?”
Lindsey Johnson, a clinical counsellor from Columbus, explained that she works in community mental health and that the vast majority of her clients are on Medicaid.
“Their Medicaid coverage is fundamental to their well-being,” she told me. “Medicaid insurance is a basic human right and without it, my clients’ physical and mental states would inevitably worsen — resulting in more homelessness and expensive trips to the emergency room.”
Amber Prater, a medical student at the University of Dayton, wrote about the current inequality in the health-care system.
“Patient populations that benefit from Medicaid already experience significant disparities in health care, and increased eligibility requirements and administrative tasks would likely cause many to lose their insurance coverage, increasing health inequity in Ohio,” according to her.
Miranda Yaver, an Assistant Professor of Health Policy and Management at the University of Pittsburgh, believes that work requirements will not increase employment.
“Extensive research on the subject has consistently demonstrated that this is simply not true,” Yaver said.
Yaver cited a study conducted by Harvard physician Benjamin D. Sommers and published in September 2020. Sommers and his colleagues conducted a phone survey of 2,706 low-income adults to examine the outcomes of Arkansas’ work requirement program.
Despite an 18-month follow-up period, they discovered that work requirements did not lead to increased employment. To make matters worse, “people in Arkansas ages 30-49 who had lost Medicaid in the prior year experienced adverse consequences: 50% reported serious problems paying off medical debt, 56% delayed care because of cost, and 64% delayed taking medications because of cost.”
Yaver comments on the findings, writing, “These are not health outcomes to which we should aspire replication.”
Another respondent claims that the Ohio Department of Medicaid misrepresented her work to support their proposal.
“On its first page, the waiver application referenced here erroneously cites a paper I published with my colleague Dr. Laura Gottlieb in 2014 as supporting work requirements in Medicaid, without presenting a single quotation or even a page number from the article as an example,” wrote Paula Braverman, Professor of Family and Community Medicine at the University of California.
The application states that “there is a strong connection between improved health and being employed and engaged in one’s health choices,” and it links to a report published by Braverman and Gottlieb.
“Our work does not support work requirements in Medicaid,” Braverman concluded definitively. “Denying people medical care if they don’t have paying jobs is cruel and inhumane.”
The history of Medicaid work requirements
In 2014, the Affordable Care Act allowed states to expand Medicaid eligibility to non-elderly adults earning up to 133% of the Federal Poverty Level.
Since then, Republican-led states have supported work requirements, often backed by think tanks such as ALEC and Americans for Prosperity.
In Ohio, think tank The Buckeye Institute supports the state’s request for a work requirement waiver.
Rea Hederman Jr., vice president of policy at the Buckeye Institute, believes that adding work requirements promotes self-sufficiency and lifts Medicaid recipients out of poverty.
“Medicaid is a program that discourages work effort, because enrollees can lose benefits when their earnings surpasses the income limit,” Hederman, Jr., stated. “When employees work, they gain not only wages but also work experience, which increases wages over time.
As a result, Medicaid enrollees may lose hundreds of thousands of dollars that they would have earned if they worked consistently.
Kathryn Poe, a researcher for think tank Policy Matters Ohio, disagrees.
“Shockingly, this is one of the few areas of policy where there is no evidence to support it,” Poe said, citing other states that have implemented work requirements. “The data from these programs clearly shows that they do not work.
They increased the administrative burden. They increased the amount that a state must spend per person. They frequently confuse people, both inside and outside of government, but they consistently kick people off of their coverage.”
President Donald Trump has advocated for work requirements since his first term in office, and many see his return to the White House as an opportunity to implement such programs across the country. U.S. House Speaker Mike Johnson has made linking work to Medicaid a key component of budget negotiations for the 2025 spending bill.
