Bolstered by a rapidly growing Medicaid population and encouragement from the Trump administration, Louisiana is eyeing an effort that would require able-bodied adults to seek employment if they want to keep their government-backed health care coverage.
The Senate Health & Welfare Committee on Wednesday didn't go along with Senate Bill 188, which would have set the wheels in motion toward an August 2018 target for submitting a request to the federal government for a waiver to implement work requirements. But members did agree that the idea should be studied.
The plan is expected to be revived as a study resolution, a looser legislative procedure, to provide more insight and data on the proposal.
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Sen. Sharon Hewitt, a Slidell Republican, said that she is worried about the Medicaid enrollment growth and the future costs as more people join.
"The growth is unsustainable," she said during a hearing Wednesday. "I feel very strongly that as a state this is an issue we are going to have to come to grips with."
Hewitt said her goal is to drive more people into the workforce, so they no longer rely on Medicaid for coverage.
"That really is the driver behind all of this. It helps people," she said. "Our goal should never be to keep people on Medicaid."
Louisiana already mandates work requirements for food stamp recipients, following an executive order by Gov. John Bel Edwards, a Democrat.
Hewitt cited that program as a potential model for placing work restrictions on Medicaid.
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But leaders from the Louisiana Department of Health and some senators expressed concern over the potential cost and resources needed to get a plan in place and seek a federal waiver at this time. LDH currently is under the threat of budget cuts, which leaders cited as a hurdle for taking on a new mandate with no guaranteed outcome.
"It's unclear at this point whether or not it's a clear path," said state Medicaid director Jen Steele.
No state has been able to secure a waiver from the federal government to place work restrictions on Medicaid. Medicaid is administered separately by the states but it is largely paid for by the federal dollars and falls under some federal restrictions.
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Health leaders in the Trump administration signaled an openness to such requests in a letter to governors earlier this year.
Hewitt said she has been in touch with officials in Kentucky who are currently in the process of seeking such permission.
Since expanding its Medicaid criteria under the federal Affordable Care Act, Louisiana has added more than 423,000 people to the rolls.
Under the expansion, which is an opt-in provision for states, adults who make less than 138 percent of federal poverty level — about $33,500 a year for a family of four or $16,200 for a single adult — can qualify for free health care coverage.
Sen. Regina Barrow, D-Baton Rouge, said that she wanted to see more information about the state's workforce capacity before requiring employment for health care coverage.
"I believe 99 percent of the people who are unemployed want to work. Most people want to work. There are barriers," she said. "We have no idea how we can effectively make this program work."