GUEST COMMENTARY: A rebuttal to Wallingford on Medicaid and employment

On April 22, Sen. Wayne Wallingford (District 27-Cape Girardeau) shared in this space his reasons for supporting work-hour-tracking requirements for some recipients of Medicaid. Yet similar proposals have been challenged in federal court.

U.S. District Judge James Boasberg recently ruled that Kentucky could not implement a similar program, and that one in Arkansas could not continue. In his decision, Boasberg said requiring such documentation of work hours was "arbitrary and capricious because it did not address ... how the project would implicate the 'core' objective of Medicaid: the provision of medical coverage to the needy."

At Empower Missouri, we are very thankful for the Medicaid program, because we are aware that it saves tens of thousands of lives in Missouri every year. It is not an employment and training program, but rather seeks to improve health outcomes among those who cannot afford the high costs of medical care nor access private insurance.

Earlier this year, our executive director testified against a bill that would create the kind of work-hour-tracking requirement that Sen. Wallingford described in his column. One of our main fears about such a program is that the Family Support Division (FSD) would be unable to accurately handle the administrative duties of tracking weekly documentation of work activities. The Division uses online tools and a call center to help Missourians sign up for public benefits programs, and neither works very well for those struggling to survive in the chaos of poverty. Many report waits of over 30 minutes to receive an answer at the call center, and lost application forms and supporting documents have been reported to our office repeatedly since FSD began a major reorganization in 2013.

Missouri has recently seen a significant drop in the number of children enrolled in Medicaid. 56,716 children lost coverage from January to December of 2018. We wonder what role the constant reorganization of staffing, policies, practices and procedures has played in this decline.

Even if FSD was able to handle paperwork from clients perfectly, multiple studies by academic and governmental sources have found that bureaucracy and poverty do not mix well. The Hamilton Project Report from Brookings (October 2018) concluded that "work requirements add complexity to social programs and risk keeping benefits from parts of the population that should be receiving them." Indeed, 18,000 Arkansas enrollees lost Medicaid coverage following their recent implementation of a work-hour-tracking mandate. It is likely that many of those could have qualified for an exemption if they had the luxury of time and resources needed to appeal the adverse action.

Sen. Wallingford is someone we respect. He has been a champion on several issues that Empower Missouri supports, including changing the law in 2018 so that most 17-year-olds will be kept out of adult courts and prisons. However, we must disagree with him regarding the proposed change to Medicaid.

We hope that Sen. Wallingford and other legislators will consider the reality that, if this legislation were passed, only unpaid work would meet both the work eligibility requirement and the income requirement to access Medicaid, because Missouri's income eligibility guidelines are among the lowest in the nation. If we had joined other states in improving our income guidelines for Medicaid, we could have covered more than 300,000 workers with low wages who are in the coverage gap, unable to qualify for Medicaid or the marketplace plans of the Affordable Care Act.

It would do much to help our state, including bringing many more federal dollars in and reducing the number of uninsured, if Missouri legislators would vote to improve our earnings rules and close that gap. That is a way to truly support both work and access to health care.

Tracy Morrow is the Health Care Organizer, Sikeston Empower Missouri.