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A new lawsuit argues that imposing work requirements in Medicaid is “threatening irreparable harm to the health and welfare of the poorest and most vulnerable in our country.”
One of West Virginian Together for Medicaid’s national allies, The National Health Law Program, filed the lawsuit against the Trump administration this week for approving work requirements in Arkansas. The lawsuit asserts that Medicaid work requirements are not within the Trump administration’s authority under the Medicaid statute without action from Congress. In June, a federal judge blocked similar Medicaid work requirements in Kentucky, the first court test for the Trump administration’s initiative.
It is likely that this issue will end up before the U.S. Supreme Court. The Court will have to decide about the future of the Medicaid program and whether the President and the Executive branch alone – without action by Congress – can undermine the statutory purpose of Medicaid and add new eligibility restrictions to Medicaid.
If Brett Kavanaugh is confirmed as a new U.S. Supreme Court Justice, many consumer protections for Medicaid enrollees could be lost. (See more about Judge Kavanaugh and the critical vote of Senator Manchin here and here.)
We worry that if our state moved in this direction, West Virginia Medicaid enrollees could be harmed by a work requirement. Not for failing to work if they are deemed capable, but by simply failing to meet reporting requirements.
"However, since one in three Medicaid adults never use a computer or the internet and four in ten do not use email, many enrollees would face barriers in complying with work reporting requirements to maintain coverage," according to a new Kaiser Family Foundation brief.
According to the West Virginia Department of Health and Human Resources (DHHR), 66% of adult and child Medicaid enrollees in WV are in families with a worker. They are servers in restaurants, home care workers, retail workers, child-care workers and others. Some enrolled in the Medicaid expansion don’t work for wages but take care of elderly parents or children. Others are in school or looking for work or they are in-between jobs. Still others have chronic health problems, a mental illness or substance abuse disorder that makes it difficult to work. Many of these workers have seasonal jobs or other types of employment with fluctuating hours and/or temporary lay-offs.
New data released by the state of Arkansas this week show Medicaid enrollees who are subject to the work requirement struggle to comply. The data show that those who must tell the state what they're doing to meet the requirement are overwhelmingly failing to do so.
In July — the second month in which the work requirements were in effect — 12,722 people either failed to report their activities to the state or didn't meet the 80-hour-a-month requirement.
The vast majority of those people — about 12,587 — didn't log on to the state's Medicaid website and report their activities. The remaining 135 people did report their activities but failed to meet the 80-hour threshold.
A new study released Monday afternoon by Health Affairs found that in states that expanded Medicaid, there was a 40 percent increase in patients filling their diabetes prescriptions. The chronic health condition, which requires daily medication to maintain, is prevalent among West Virginians of all incomes. The price of insulin has increased sharply in the last decade. Untreated, diabetes can lead to more serious complications like kidney damage or heart disease.
As reported by Kaiser Health News, the study “shows that the Medicaid expansion can help patients manage their health and also limit unnecessary spending. An analysis by the Centers for Disease Control and Prevention cited by the study shows that each diabetic patient who is treated for the condition can lead to a $6,394 reduction in health care costs (in 2017 dollars) because of fewer hospital admissions.”
In March, Secretary of Commerce Wilbur Ross directed the Census Bureau to add a citizenship question to the 2020 census. This proposal discourages participation, threatening the accuracy of the count and goes directly against the vital need to address the census’ historical under-counting of immigrants, low-income people, people of color and other under-served communities. Census data are used to appropriate hundreds of billions of dollars in federal funds for critical health and social programs, including Medicaid.
What Health Advocates Can Do
Submit a comment letter to the Department of Commerce urging Secretary Ross to remove the citizenship status question from the Census. Submit your comments online HERE by August 7.
West Virginians Together for Medicaid strongly opposes the addition of a citizenship question to the 2020 Census. Asking an untested question about citizenship status will increase fear in immigrant communities – among people with undocumented status, legal non-citizen status and U.S. citizens alike – and decrease Census participation
We believe a full, fair and accurate census and the collection of useful, objective data about our West Virginia communities is very important. The federal government uses census-derived data to direct at least $800 billion annually in federal assistance to states, localities and families. About 61% of all funding guided by Census data is related to health programs. A full, fair and accurate census is critical for the functioning of many key health programs and for the health and well-being of all West Virginia communities.
We are particularly concerned about the impact on funding for Medicaid and the Children’s Health Insurance Program (CHIP), which improve access to care and health outcomes and reduce disparities. The data used to calculate the federal funding states receive to run their Medicaid and CHIP programs are derived from the Census, so any systematic undercounting of low-income communities could put Medicaid and CHIP funding in jeopardy. Any cuts to funding would almost certainly translate to fewer services for people receiving coverage through these programs, putting access to care and health outcomes at risk for low-income children, adults and people with disabilities, including citizens.
West Virginians often move on and off Medicaid eligibility as they struggle to move forward financially. For example, someone with a part-time job might see their hours fluctuate and this can change whether they are income eligible for Medicaid. Many West Virginians who rely on Medicaid during hard times find that they transition off Medicaid when their income is restored or goes up – even if they don’t have a job with health insurance benefits. For these West Virginians, shopping for health insurance is a daunting task. And unfortunately, as we wrote in yesterday’s blog, the Trump Administration has slashed funding for health insurance navigators who help people understand their health insurance choices.
Now to make the task even more challenging, the Trump Administration has issued a new rule that allows so-called “short-term plans” to be sold. These plans do not have any of the consumer protections that are part of the Affordable Care Act. There are no required basic benefits (such as prescription drugs, mental health services, rehabilitation services) and they can charge people with pre-existing conditions more and include “riders” that exclude coverage for pre-existing conditions. They can penalize older people and sicker people (or people who they deem might get sick) with high premiums and copays.
So please buyer beware! These plans could mean you pay premiums for the privilege of being uninsured. These plans are really “swiss cheese plans” – more holes than coverage and they melt away when you get sick and need them the most. And remember, read the fine print. Lower premiums are attractive – but you may end up paying more later out of your own pocket.
Trump Administration Navigator Funding Cuts Leave West Virginians To Find Their Own Way to Affordable Health Insurance
Last week, the Trump administration announced a drastic cut, nearly 90 percent from 2016 funding levels, to Affordable Care Act navigator funding. These grants have provided several years of critical, unbiased, in-person assistance through ‘navigators’ to help individuals and families enroll in health insurance.
WV Navigator is a grant funded program that provides free health coverage enrollment assistance to uninsured West Virginians. Trained and certified navigators help consumers enroll in qualified health plans through the Health Insurance Marketplace or, if eligible, WV Medicaid. Navigators help consumers determine eligibility for health coverage and financial assistance for health coverage. In West Virginia, West Virginia University Research Corporation and First Choice Health Systems received grants of $300,000 each in 2017.
This year the West Virginia total federal navigator program budget will be cut from $600,000 to $100,000 – a 83 percent cut in funding. This funding decision is but the latest in a series of blows to the enrollment community in the past two years. Looking across the country, the inadequate $10 million navigator grant is an 84 percent cut in services since 2016 and a 42 percent cut over last year’s already meager spending levels.
Cuts of this magnitude stretch the navigator program to the breaking point. It makes it significantly harder for West Virginians to learn about the availability and affordability of plans, leaving consumers too often with few, if any, resources for understanding their health insurance options. Consumers in our state will be lost in the forest of health insurance choices without an experienced guide.
Please Call our Congressional Delegation to reverse these cuts by restoring and increasing investments in enrollment and health literacy assistance now and for years to come.
Jennifer D. Oliva, Associate Professor of Law and Public Health, West Virginia University College of Law, in an Opinion Editorial in today’s Charleston Gazette-Mail (Health care, lives will be affected by Supreme Court choice) warned that, “…ACA proponents are wise to be concerned about the future of health care reform in the hands of a high court that includes Brett Kavanaugh.”
The OpEd is worth a read. Professor Oliva also warns, “Some legal experts argue that Kavanaugh might be inclined to reverse (the Kentucky Medicaid work requirements federal court decision), thereby stripping 400,000 Kentuckians of their Medicaid coverage – based on the legal theory that poor people lack standing to sue the government under the Medicaid statute.”
“In West Virginian, where over half-a-million people receive Medicaid, a legal ruling blocking access to the courts could literally cost lives.”
Professor Oliva concludes, “In sum, ACA supporters should be worried the Senate might confirm Judge Kavanaugh’s nomination to the Supreme Court. Those who live in Medicaid expansion states, including West Virginia and Kentucky, should be particularly alarmed about that possibility. The future of health care reform hangs in the balance.” (Emphasis added)
Senator Joe Manchin is encouraging West Virginians to send him their thoughts on Supreme Court nominee Brett Kavanaugh. Constituents can submit their views of Judge Kavanaugh through a form on Manchin’s Senate website or by emailing SCOTUS@manchin.senate.gov.
If Brett Kavanaugh is confirmed, he will be sitting on the Supreme Court when cases are decided that could take away consumer protections for pre-existing conditions and scale back Medicaid. Literally hundreds of thousands of West Virginians could lose their health insurance coverage. The stakes are very high. Please let Senator Manchin know your opinion.
Senator Joe Manchin is encouraging West Virginians to send him their thoughts on Supreme Court nominee Brett Kavanaugh.
A website and email address have been set up by Manchin’s office for constituents to comment on the federal judge.
Constituents can submit their views of Judge Kavanaugh through a form on Manchin’s Senate website or by emailing SCOTUS@manchin.senate.gov.
If Brett Kavanaugh is confirmed, he will be sitting on the Supreme Court when cases are decided that could take away consumer protections for pre-existing conditions and scale back Medicaid. Literally hundreds of thousands of West Virginians could lose their health insurance coverage. The stakes are very high.
See this background fact sheet on Judge Kavanaugh.
On Friday June 29, Federal Judge James E. Boasberg rejected Kentucky Governor Bevin and the Trump administration’s attempt to fundamentally alter Kentucky’s Medicaid program and make it much harder for vulnerable families to receive health care. Specifically, the court ruled that the Center for Medicare and Medicaid Services (CMS) did not have the legal authority to approve a request by Governor Bevin to tie Medicaid eligibility to work requirements and new administrative reporting burdens.
Last summer, people of compassion across the country were fighting to prevent the United States Congress from repealing the ACA and slashing Medicaid funding by billions of dollars. And we won.
An important part of the strategy that gave us that victory was sharing the stories of people on Medicaid with the media and with Members of Congress.
Below you can go to an excerpt from the beginning of a piece that appeared in the New York Times on May 3, 2017. Alice Wong tells her story of how Medicaid has changed her life. Please read the full piece by Alice and send copies to others.
There is no question that Alice is a powerful advocate for people with disabilities.
But anyone who shares their story can share that power and make a difference.
Go to Share Your Story and we will contact you. You control your story - we will talk to you about if and how you might want to share your story and help protect Medicaid.