NASHVILLE, Tenn. — Tennessee is asking President Donald Trump’s administration to join the ranks of states requiring able-bodied, low-income adults to work, volunteer or take classes in order to keep their government-funded health care.
At the direction of the GOP-led state Legislature, Tennessee has requested federal approval to impose the requirement on about 56,000 low-income adults if they want to keep their Medicaid health coverage that is offered under the TennCare program.
In a Dec. 28 application posted online by Medicaid this week, state health officials gave their most detailed outline to date about how they would implement work requirements. The requirement would not apply to the elderly or disabled, or pregnant women.
The state is following Trump’s call to wean poor people from government benefits, but critics say the work requirement could undermine critical access to health care and cost much more than it would save.
TennCare’s plan would require that, for at least four months out of six-month periods, beneficiaries must log 20 hours weekly on average of qualifying work, community service, or education. Violators would face suspension until they show they have complied for a month, though TennCare may offer ways to regain coverage before that.
A number of groups would be exempted, including one primary caregiver per household with a child younger than 6, those on short- or long-term disability or with certain acute medical conditions, caregivers for the disabled or medically frail, people receiving unemployment benefits, and others. Other circumstances could warrant a “good cause” exemption.
The state would count work required under other public assistance programs, and also would leave the option open to loosen or remove the requirement in economically distressed counties.
Trump has come up short in his efforts to repeal former President Barack Obama’s Affordable Care Act, which includes Medicaid expansion in states. Centers for Medicare & Medicaid Services administrator Seema Verma is encouraging states to set work requirements for Medicaid, contending that will encourage people to earn their way out of poverty and dependence on government insurance.
Arkansas officials say nearly 17,000 people have lost Medicaid coverage through November since it became the first state to implement the requirements in June. That initiative is being challenged in federal court. In Kentucky, a federal judge blocked work requirements in June, but the state has since gotten the Trump administration’s approval for new rules that could begin to be phased in by April. Both of those states expanded Medicaid eligibility under the Affordable Care Act.
However, in Tennessee, GOP lawmakers have rejected efforts to add about 300,000 people to the TennCare rolls. About 1.3 million people have TennCare coverage, primarily low-income pregnant women, children up to age 21, the elderly and the disabled. About 56,000 would be affected by work requirements, TennCare estimates.
Craig Becker, the Tennessee Hospital Association’s president, said the work requirement is an “an odd fit” for Tennessee because, after refusing to expand its Medicaid rolls, the state only has a limited number of able-bodied adults who would qualify. Any potential savings would not make up for the tens of millions of dollars in projected costs for case management and linking beneficiaries to training and support, including child care and transportation, he wrote.
“Implementing the work requirement and community engagement program described in this amendment is premature and should not be considered until the program has added coverage for adults without dependent children or family members, a group for which the work and community engagement requirements may be more applicable,” Becker said.
The state counters that it could cover the costs using Temporary Assistance for Needy Families money, a move that needs federal approval.
Many health groups — from cancer to mental illness advocates — also worried about how the state will define “medically frail,” though the state said it will develop definitions consistent with federal requirements.
Other concerns were raised about how beneficiaries would report their hours, citing a lack of Internet access for some on TennCare.
The American Cancer Society is among the groups worried about bureaucracy, saying a “burdensome documentation process” could mean some people are locked out of coverage or dis-enrolled, “jeopardizing access to life-saving treatment.”
The state said it’s still mulling exactly how beneficiaries will document hours and receive exemptions, saying it needs to “strike a balance” between ensuring accuracy and minimizing administrative burden on TennCare recipients.