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Medicaid work requirements

Posted on January 12, 2018

Gov. John Bel Edwards said this week that his administration is “actively working” to develop a work requirement plan for able-bodied Medicaid recipients. The governor’s announcement came on the same week that President Donald Trump’s administration announced that it would start approving such plans, which had never before been allowed in the Medicaid program. In a letter outlining the new policy, Center for Medicare and Medicaid Services deputy administrator Brian Neele states that work requirements promote health and well-being. However, studies have shown that work requirements may actually decrease work participation by denying people access to health care and add additional expenses to state government. Furthermore,  a majority of working-age Medicaid beneficiaries are already working, in school or seeking work. The AP’s Melinda Deslatte reports.

“We’re looking at people who are able-bodied, and it has to accommodate those who are in work training or education,” he said. “We’re looking for a requirement that actually make sense.”  …  The federal guidelines say the administration would consider work requirements for “able-bodied, working-age” Medicaid recipients. States could require alternatives to work, including volunteering, caregiving, education, job training and treatment for a substance abuse problem. The guidance said states should exclude pregnant women, disabled people and the elderly and take into account hardships for people in areas with high unemployment, or for people caring for children or elderly relatives.

The legality of work requirements is being questioned by some lawyers, who say they it is in direct opposition to Medicaid’s core mission.  Section 1115  of the Social Security Act allows states to diverge from certain Medicaid requirements, but only if these changes “further the objectives” of Medicaid. The Washington Post’s Amy Goldstein has more:

[Leonardo] Cuello said the argument that work promotes health is “totally contorted . . . It’s a little like saying that rain causes clouds. It’s more that people [with Medicaid] get care, which helps them be healthy and makes them able to work.” In a letter Thursday to Brian Neale, the CMS deputy director who oversees Medicaid, the organization said the administration’s new policy “entirely ignores the wealth of literature regarding the negative health consequences of work requirements” and was issued without any opportunity for public input.

LBP’s Jeanie Donovan weighed in on the issue last year as the Senate was considering a bill to mandate work requirements. The bill was shelved amid strong opposition from health and consumer groups.

 

Clock is ticking on the cliff

Gov. John Bel Edwards will release a draft budget to legislators one week from today, outlining his plan to solve the $1.5 billion fiscal cliff that Louisiana is facing when temporary taxes expire on June 30. Unfortunately, there seems to be no plan to solve this fiscal crisis from the state House, the place  where all tax bills must originate. The Advocate editorial board describes the tight timeline and urges lawmakers to work with the governor.

As the governor noted in his talk, a special session is required to raise “new” revenue to replace the “temporary” sales tax and other expiring laws. That requirement of the Louisiana Constitution — the legislative session this year cannot take up taxes — means that the dodging and weaving by state House leadership cannot go on forever. They call the expiring taxes the “fiscal cliff” at the State Capitol. Legislators seem unwilling to act until there is no ground under their toes, and Edwards — as well as college presidents and agency heads who have to develop their own budget plans — has a right to be frustrated by the intransigence of the House.

 

Short term benefits of tax bill on hold

Supporters of the recently passed GOP tax bill claimed in December that the public’s poor opinion of the legislation would improve when people saw increases in their paycheck in January. However, workers will have to wait longer than expected for this short term benefit, as the rushed process to pass this legislation has caused confusion between the IRS and businesses. Vox’s Emily Stewart explains.

The IRS said in late December that it is “working to develop withholding guidance” to implement the tax reform legislation and anticipates the initial withholding guidance to be out sometime in January. After that, it should take companies about four to six weeks to implement the changes. “Some companies might not be so nimble,” said Bill Dunn, director of government relations at the American Payroll Association, which represents about 21,000 payroll administrators at around 17,000 employers across the US. “It could take longer if the change is more complicated than we think it’s going to be.”

 

Huge changes proposed for TOPS

The chairman of a legislative task force charged with recommending changes to the TOPS scholarship program is recommending sweeping changes. Sen. Blade Morrish’s plan would replace scholarship awards with a less generous stipend for the most common form of TOPS, redistribute annual stipend amounts for the top two levels of the program and create a new category called Honors Plus. The Advocate’s Will Sentell has the story.

Under the plan, students who get the most common form of TOPS — called TOPS Opportunity– would get a $4,000 annual stipend, a reduction from current aid levels. [Blade] Morrish said the current funding model is antiquated. “It is in the 20th century, not the 21st century,” he said. The average annual tuition at four-year schools in Louisiana is $5,620, with LSU’s higher…Morrish said that while $4,000 annually seems low, it would still be the most lucrative such program in the nation. The panel has been studying the issue for months. “We have done our work,” Morrish said. “It is time to make proposals.”

 

Number of the Day

67 – percent of Medicaid recipients in Louisiana who are children, seniors or disabled. (Source: Louisiana Department of Health

 

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