Reader: Medicaid work requirements are poorly designed


The Michigan Legislature recently passed legislation requiring about 500,000 Medicaid recipients to work or to face possible cancellation of Medicaid benefits.

The Michigan Department of Health and Human Services is requesting a waiver from the federal government to implement the requirements. While there is support for expecting people to work when possible, the proposed waiver is poorly designed and will not accomplish the intended goals.

There is little or no evidence that the work requirements will result in more people getting jobs. People will lose access to basic health care and to preventive services. Cancellation of Medicaid will drive them into more costly acute and chronic care services that we will pay for in the long run. Furthermore, the administrative challenges are likely to cost more to implement than they will save. I recently documented these findings in testimony to the department regarding their proposed waiver.

Michigan has the opportunity to revise the Medicaid waiver from a compliance model to a supportive approach addressing barriers to self sufficiency. After reviewing the new legislation, it appears this can be accomplished within the language of the new law.

I developed and implemented work requirements for welfare programs in several states.

In Colorado Springs, we implemented time limits and work requirements for the cash assistance program called Temporary Assistance to Needy Families (TANF). At the beginning of the program, we had about 3,800 families facing a five-year time limit. After five years, only 12 of the 3,800 original families remained on TANF. All of the others got jobs, were transferred to other forms of assistance or voluntarily left the program. Not a single family was terminated from the program for failing to meet work requirements. Of the 12 families remaining after five years, all were re-evaluated and determined to be disabled or otherwise exempt from the work requirements.

The key to this success was the development of individualized plans. Families were not told how many hours they needed to work. Instead, all participated in an assessment to determine their strengths, abilities and barriers to self sufficiency. All were accountable for developing a plan built on their own goals and strengths while addressing what they identified as barriers to their self sufficiency.

Everyone should work toward his or her own success and self sufficiency. But the plans must be individualized and owned by the clients. In this model, compliance for the most part becomes a non issue because plans are developed and owned by the recipients. People are not coerced to comply but rather supported to succeed. My experience has shown that people live up to higher expectations but fight compliance when the system assumes they need to be coerced.

We are all accountable for improving our lives and for being as successful and self sufficient as possible. This is best accomplished through support and encouragement rather than though compliance and punishment.

David A. Berns, LCSW, retired



Posted by Daylan Nickisson

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