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Politics & Government

Federal Report Finds Medicaid Work Requirements Are Costing States Millions

James Dawson
Boise State Public Radio
Protesters outside the Idaho Capitol in 2019 demanded a 'clean' implementation of Medicaid expansion. State lawmakers eventually passed several restrictions, including work requirements.

An independent, federal watchdog agency has found some states that have implemented work requirements for Medicaid recipients did not reveal the full costs to get those programs running.

The report by the Government Accountability Office, or GAO, looked at five states that have spent hundreds of millions of dollars on making sure Medicaid participants are working.

Kentucky, for example, has spent at least $270 million – mostly to set up a new computer system. Feds have picked up much of that tab, but the state is still paying tens of millions.

The other states the GAO looked at were Arkansas, Indiana, New Hampshire and Wisconsin. Combined with Kentucky, these states estimate they’ve spent $408.3 million to implement their respective Medicaid work requirement programs, affecting nearly 1.4 million people.

Those estimates don’t factor in ongoing costs.

Carolyn Yocom helped write the report for the GAO. She said states didn’t have to reveal any cost estimates when they applied for the waiver.

“If it’s not reported, no one can review and comment on it. So, there’s added costs that are a concern, but then there’s also a transparency concern,” Yocum said.

The federal Department of Health and Human Services didn’t agree with the GAO’s recommendation to require this kind of transparency, saying, “…we can expect administrative costs over the life of a [work requirement waiver] to be a relatively small portion of the total cost. Therefore, we believe making this information available as a part of the transparency requirements would add little to no value…”

The Centers for Medicare and Medicaid Services has approved waivers in four other states and Idaho is in the process of submitting its own.

Rep. Bryan Zollinger (R-Idaho Falls), who worked on a bill drawing up guidelines for the waiver, said Idaho lawmakers estimated about $1.4 million in ongoing costs to oversee the work requirements if they’re approved.

“I don’t want any more costs than we can save through the program itself,” Zollinger said.

He said he doesn’t think costs will escalate as much as other states, but he says he’s willing to revisit the issue if they do rise significantly.

A group of state lawmakers is currently drafting recommendations on how the legislature should pay for the estimated $41 million Medicaid expansion is expected to cost Idaho next fiscal year.

If approved by the federal government, Idaho’s program would require those covered by Medicaid expansion to work, study or volunteer for at least 20 hours per week.

Many people would be excluded from those requirements, including those older than 59, anyone who’s physically unable to work, parents of minor children and those who take care of family members with serious medical conditions or disabilities.

Ultimately, Zollinger said he thinks work requirements for Idaho’s Medicaid expansion population would help lift people out of poverty.

A decision by the federal government on the state’s waiver isn’t expected for months.

Follow James Dawson on Twitter @RadioDawson for more local news.

Copyright 2019 Boise State Public Radio