The current version requires certain adults to log at least 80 hours a month of “community engagement,” which could be employment, school or volunteer work. As proposed, the rule would pertain specifically to adults ages 19 to 64 who qualify for Medicaid as part of an expansion under the Affordable Care Act. Pregnant women, parents and caregivers of young children, and people with mental and physical disabilities would be exempt.
Rep. David Valadao, a California Republican who represents portions of the San Joaquin Valley that have some of the highest Medicaid enrollment, told ABC’s Bakersfield affiliate that work requirements are a fair ask.
“For those who are able-bodied with no dependents and you choose not to try to make that effort to go get a job, go to school or volunteer, do something in your community, yeah you’re probably going to be affected by this, but the average person who is working really hard to provide for their family thinks that’s the right thing to do,” Valadao said.
But Rep. Laura Friedman, a California Democrat representing Los Angeles, said it is the responsibility of the government to help people stay safe and healthy, but work requirements would do the opposite.
“They want to make it so hard for you and your family to access care with these onerous work requirements that you say ‘I’m not even going to bother, I’ll just try not to get sick,’” Friedman said during a press conference this week.
Friedman said the proposed cuts and requirements in the House bill would lead to more uncompensated care costs for clinics and hospitals, which ultimately could lead to reduced services for entire communities.
As currently drafted in the House bill, work requirements would kick in on Dec. 31, 2026. States would have the option to start earlier.
In addition to the work rules, the House budget bill proposes several other changes, including requiring these enrollees to verify their income every six months, rather than once a year. A separate measure seeks to financially penalize states that offer non-emergency Medicaid coverage to undocumented people, even if it’s with state-only funds, as California does. And less federal funding may force states to reduce benefits or enrollment.
The federal proposals are on top of changes that Gov. Gavin Newsom is already eyeing that could also force people to lose their health insurance. In his most recent budget proposal, Newsom proposed benefit reductions, a premium charge and enrollment freezes for undocumented residents as the state deals with a projected $12 billion shortfall.
All of the proposals at the federal and state level are bound to result in confusion and disruption for patients, Alfaro said.
“Last year we were doing a bunch of promotion around how easier it is to get health insurance,” she said. “And it seems like now we’re going a step backwards.”
The Arkansas and New Hampshire experience
Currently about 5 million Californians with Medi-Cal are eligible because of the Affordable Care Act’s Medicaid expansion. The 2010 health law allowed states to add adults without children or a disability to their rolls. It’s this group of enrollees that would be subject to the work requirements.
The Urban Institute’s estimate of more than a million of them losing coverage in 2026 is based on multiple factors, including trends and experiences observed in Arkansas and New Hampshire.
In 2018, Arkansas became the first state to implement work rules as a condition for Medicaid coverage. The rule applied to adults ages 30 to 49 who had to show 80 hours of work a month. Within six months, 18,000 adults had lost their coverage. In 2019, a federal judge struck down the state’s work requirement.
State lawmakers in New Hampshire said they’d do a better job than Arkansas in rolling out their own 2019 work requirement, but they faced similar challenges. The state had a difficult time reaching enrollees and notifying them about the changes, news reports at the time show. On track to lose thousands of people more than anticipated, the state suspended its rule.
“Based on the experience of other states, even if you spend a ton of energy on outreach, a lot of people just don’t realize what they have to do,” said Nari Rhee, director of the Retirement Security Program at the UC Berkeley Labor Center. “People have a bunch of questions: ‘Am I exempt? What do I have to do?’
“Even in New Hampshire, where they thought they were being gentle about the rollout, people had a hard time getting through (phone lines) to ask questions,” Rhee said. “So you can expect a pretty large percentage of people who could meet the requirements just fine, basically falling through the cracks and losing coverage because they just didn’t know or couldn’t get the information they needed.”
This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.
