Indiana to Join Kentucky in Tying Medicaid to Work

Indiana to Join Kentucky in Tying Medicaid to Work

The new Secretary of Health and Human Services, Alex Azar, will announce today that Indiana will follow Kentucky's lead and receive approval to implement work requirements in the state’s Medicaid program, according to a Politico report. Last month, the Trump administration signaled they’d allow requiring work for low-income people seeking health-care assistance, and Kentucky quickly became the first state to receive the greenlight to radically change their Medicaid model.

Indiana actually inspired some parts of Kentucky’s plan, as the state has included aspects of “consumer-driven” health insurance, like premium payments, in its Medicaid program since 2015. Data show that 25,000 Medicaid recipients were dropped from Indiana’s Medicaid program between 2015 and 2017 for failing to pay their premiums.

Now, like Kentucky, Indiana will be adding work requirements to the mix.

But not so fast. Three organizations have brought a lawsuit against the state of Kentucky on behalf of 15 Kentucky Medicaid recipients, alleging that forcing Medicaid recipients to work to continue receiving health care is a violation of federal law. The Kentucky Equal Justice Center, the Southern Poverty Law Center, and the National Health Law Program are arguing that the Trump administration’s willingness to allow work requirements and their approval of Kentucky’s plan to restructure Medicaid “are unauthorized attempts to re-write the Medicaid Act.” As I reported in September, nearly 100,000 Kentuckians are expected to lose Medicaid as a result of the approval to change the state’s program.

The Obama administration resisted allowing work requirements in Medicaid, reasoning that such requirements, which would reduce coverage, were inconsistent with the purpose of the program: to provide health care to low-income people.

As more states add a work requirement to Medicaid receipt, the benefits of Medicaid expansion (more people accessing preventive care and folks getting healthier) will begin to erode. While states with conservative governors may be willing to expand Medicaid if it means they can require poor people to work, this would be a Pyrrhic victory for the left: Work requirements mean that the neediest people won’t receive care, and they reinforce the idea that assistance should be given only to (a harmful assumption of) who is most “deserving.”