New Hampshire should abandon its effort to impose work requirements on Medicaid recipients. They are ill-conceived, ill-designed, ill-administered and, according to a federal judge, illegal.
The new rules - which require most recipients to spend at least 100 hours a month working, going to school or participating in community service - were imposed by the Legislature and Gov. Chris Sununu when they reauthorized the state’s expanded Medicaid program in 2018. The requirements affect about 25,000 people in the program, who must document their compliance monthly.
They are ill-conceived. The expanded Medicaid program extended eligibility to those making up to 138% of the poverty threshold, or $35,535 for a four-person household - the very definition of the working poor. An estimated 65% of participants are already working and 77% come from working households.
Besides that, the whole idea of the program is that both the participants and society benefit when people have health insurance. The participants are able to obtain health care when they need it instead of waiting until they are very sick and their conditions become very expensive to treat. People with employer-based insurance benefit because their premiums no longer have to subsidize care for the uninsured. And society benefits because the general population is healthier.
Moreover, the expanded Medicaid program is key to fighting the state’s awful opioid epidemic, because it pays for substance-use treatment.
Any requirements that threaten participants with loss of coverage are not only cruel, they are stupidly counter-productive.
They are ill-designed: Making Medicaid participants provide monthly documentation of their work status ignores a fundamental reality of life for low-wage workers making ends meet by piecing together several part-time jobs. The number of hours worked can fluctuate from month to month, and the decision of how much to work is often not within the control of the worker.
In addition, day-to-day problems such as illness, family care responsibilities and transportation difficulties can and do crop up, getting in the way of complying with the 100-hour requirement.
They are ill-administered: The Sununu administration’s rollout of the new requirements, before the federal court ruling, was a fiasco. June was the first month for which participants had to document their hours. Only 8,000 were in compliance. Letters were scheduled to be sent to the 17,000 who weren’t, informing them that they were in danger of losing coverage. That was before the Health and Human Services commissioner wisely pulled the plug and delayed implementation until September, sparing state government the embarrassment of widespread noncompliance.
In the meantime, though, state workers had already begun going door-to-door in high-enrollment neighborhoods in the state’s bigger cities. And the state had already spent $130,000, to little effect, on outreach efforts such as letters, phone calls, text messages, public information sessions and information tables set up outside grocery stores and other retailers, The Associated Press reported.
Is this a good use of scarce state resources? No, it is not. It amounts to squandering them in a quixotic attempt to make an ideological point about what supposed duty low-income people owe to the state.
If Sununu truly wanted to encourage people to work, he would not have vetoed earlier this month a bill that would have raised the minimum wage in New Hampshire from the paltry $7.25 federal level to $10 an hour in 2020 and $12 an hour in 2022. That, too, was ill-considered.
They are illegal. At the end of last month, U.S. District Judge James E. Boasberg, sitting in Washington, blocked the requirements, ruling that the Trump administration had failed to address the potential for low-income residents to lose their health insurance coverage. He had previously invalidated similar rules in Kentucky and Arkansas. Noting that 18,000 people lost coverage in Arkansas in 2018, Boasberg said that New Hampshire’s program poses even greater concerns because it requires more hours of work each month and applies to a wider age range of participants.
Sununu signaled that the ruling would be appealed; what the state should do instead is repeal the requirements.