The Centers for Medicare and Medicaid Services approved Ohio’s work rules for “able-bodied” recipients of Medicare Friday.
Obamacare included a requirement that all 50 states expand Medicare eligibility to cover every individual whose income was up to 133 percent of the poverty line by January 1, 2014. In 2012, in a 5-4 decision, the Supreme Court voted to uphold much of the law while ruling the Medicaid expansion requirement unconstitutional. They found that the federal government couldn’t force the states to expand Medicaid with the threat of withdrawing existing Medicaid funding. Instead, each state would have the option to voluntarily opt into the expansion or not.
After months of deliberation, then-Ohio Governor John Kasich announced he would push to accept the expanded Medicaid in March of 2013. The once tea-party supported governor faced significant conservative pushback and criticism for accepting the expansion, most significantly for its high cost and potential government overreach.
In 2017, Kasich added provisions to the Medicaid expansion, but stipulated that certain work requirements be met before “able-bodied” men could use the program. They had to work 20 hours a week, be actively looking for a job, receiving education or training, or engaged in community service.
These measures, while supported in the state, received significant pushback from advocacy groups who argued that the requirements could lead to fewer individuals being covered. As recent as the 1990s, Democrats and Republicans agreed that work requirements for entitlements, commonly referred to as “work for welfare,” were effective and necessary. This has shifted in recent years as groups like the Center on Budget and Policy Priorities argued:
State proposals for Medicaid work requirements will cause many low-income adults to lose health coverage, including people who are working or are unable to work due to mental illness, opioid or other substance use disorders, or serious chronic physical conditions, but who cannot overcome various bureaucratic hurdles to document that they either meet work requirements or qualify for an exemption from them. These coverage losses will not only reduce access to care and worsen health outcomes, but will likely make it more difficult for many people to find or keep a job. Thus, Medicaid work requirements may be self-defeating on their own terms.
In spite of the complaints, Centers for Medicare and Medicaid Services affirmed that states like Ohio had the right to set these standards. Ohio is officially the ninth state to include such measures.
Many can claim exemption from the requirement, including those who are “50 or older, parental caretakers, people with chronic conditions, and those who qualify for the Supplemental Nutrition Assistance Program and the Able-Bodied Adults without Dependents program.”
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