Louisiana is developing a proposal to impose work requirements on certain adult Medicaid recipients, as the Trump administration announced Thursday it will allow states to enact such provisions.
Gov. John Bel Edwards said his administration is "actively working" on the concept, which would require federal approval. The Democratic governor talked of the proposal broadly in a speech Monday as part of a list of legislative agenda items, and he repeated his intention in a statement Thursday.
The details of what Louisiana is crafting — and how many low-income people in Louisiana's $12.5 billion Medicaid program it would affect — aren't clear.
Edwards said he wants the work requirements to be "reasonable," with exceptions for people in school or training programs. He said Louisiana has hired a consulting firm that helped develop a similar work requirement proposal for Kentucky, which is awaiting a federal decision.
"We're looking at people who are able-bodied, and it has to accommodate those who are in work training or education," he said. "We're looking for a requirement that actually make sense."
Because Medicaid is a government-financed health insurance program with shared expenses between the state and federal governments, the U.S. Centers for Medicare and Medicaid Services has to agree to enact such work requirements.
On Thursday, the federal agency offered a road map for states seeking support for waivers imposing the requirements. After the announcement, Edwards issued a statement saying his administration will use the new guidance to "continue developing a Louisiana-specific program for our Medicaid program as we go forward."
The governor's proposal to enact work requirements caught some off-guard, since Edwards administration officials with the state health department previously expressed concern about similar suggestions.
Critics of Medicaid work requirements say they can penalize poor people who may be unable to find employment and could lose lifesaving health insurance.
The Louisiana Budget Project, which advocates for low- to moderate-income families, said many nonworking Medicaid recipients have circumstances that make it difficult for them to work. Bumping people out of the Medicaid program could end up driving up uninsured costs that fall on hospitals, health providers and the state, the organization says.
In Louisiana, Medicaid covers 1.6 million people, about one-third of the state's population, including newborns, pregnant women, elderly nursing home residents, people with developmental disabilities and, through the Medicaid expansion, hundreds of thousands of working-age adults.
The federal guidelines say the administration would consider work requirements for "able-bodied, working-age" Medicaid recipients. States could require alternatives to work, including volunteering, caregiving, education, job training and treatment for a substance abuse problem.
The guidance said states should exclude pregnant women, disabled people and the elderly and take into account hardships for people in areas with high unemployment, or for people caring for children or elderly relatives.
State legislative efforts to try to enact Medicaid work requirements have been unable to gain traction. State Sen. Sharon Hewitt, a Slidell Republican, proposed the idea last year, but it went nowhere amid worries raised by the state health department and others about forcing people off Medicaid rolls.