On May 16, the Ohio Academy of Family Physicians submitted comments to the Centers for Medicare and Medicaid Services opposing Ohio’s 1115 Medicaid’s waiver request to implement work requirements for Medicaid expansion enrollees.
The comments attributed to OAFP president Don Mack, MD, stated in part:
“As primary care physicians serving on the front lines of patient care in Ohio, we know firsthand that approval of Ohio’s waiver application would be a devastating blow to progress made in providing health care coverage to Ohio’s Medicaid and other low-income populations. This waiver application, as written, threatens coverage of an estimated 36,000 adult Ohioans who now have coverage – a huge step backward in achieving the American Academy of Family Physicians’ long-standing goal of achieving health care coverage for all. This waiver, if approved, reverses gains made when Medicaid was expanded and care was improved by transitioning services from expensive hospital emergency departments to less expensive outpatient settings.
We understand that many states are pursuing policies to seek to undermine Medicaid expansion provided under the Affordable Care Act (ACA). This particular step in the process to dismantle the ACA will lead to broad disenrollment of Ohioans who need health care coverage. This waiver increases administrative burdens for physicians, other health care professionals, and county governmental agencies who have to implement the work requirement; thus expending more time, effort and money completing paperwork and less time, effort and money on meeting human needs.
Waivers were created to foster innovation not to undermine the original objectives of the Medicaid program. Reducing coverage and access is not the direction we should be heading as a state or nation. Please reject Ohio’s 1115 waiver application.”
Many of the 700,000 Ohioans enrolled in the Medicaid expansion already work – 58% earned income in the previous year and 44% currently meet the work requirement. Additional enrollees are exempt from the requirement based on Ohio law and new federal guidelines. As a result, an estimated 95% of the current Medicaid expansion population will meet the work requirement or be exempt, but the remaining 5% – about 36,000 individuals – would need to seek work or otherwise comply with the requirement to remain enrolled in Medicaid.
To comply with the work requirement, Medicaid expansion enrollees will need to demonstrate they work at least 20 hours a week or are engaged in other allowable activities, including job search, education and training, or unpaid work in certain cases. New enrollees must meet the requirement when they enroll, and current enrollees must meet the requirement during their annual eligibility renewal. Failure to meet the requirement results in termination of Medicaid benefits. Limited exceptions may be granted, for example for a family emergency or illness.
The AAFP has warned that states, like Ohio, who seek the flexibility to change their Medicaid programs should be careful to not harm patients by reducing access or erecting unnecessary barriers to care.
Submit comments to CMS by Thursday, June 14.