Michigan House approves Medicaid work requirement

Beth LeBlanc
The Detroit News
Sen. Mike Shirkey, R-Clarklake, is the sponsor of a Senate-approved bill that would require Medicaid recipients to work, get education or get training every week. It is scheduled for a House vote on Wednesday, June 6, 2018.

Lansing — A controversial Medicaid work requirement bill is on the cusp of going to the governor's desk after the Michigan House approved it Wednesday in a 62-47 vote. 

The Senate legislation was scaled back in a House committee so it only would apply to "able-bodied" Medicaid recipients in the state’s expanded Healthy Michigan program. As of Monday, 662,913 residents were enrolled in the program, of which about 540,000 able-bodied adults could be subject to the work rules.

House members voted on the bill Wednesday afternoon amid shouts and yells after Republicans abruptly ended the floor debate, preventing additional Democrats from speaking on the bill. 

The bill is a "common sense" reform asking able-bodied recipients to work "half as much" as the people paying for the program, House Speaker Tom Leonard, R-DeWitt, said in a statement.

“Welfare benefits should always be a hand-up, not a handout," Leonard said. "But instead our current system takes millions of dollars from hard-working Michigan families and gives completely free benefits to people who are oftentimes perfectly able to work and earn their own health coverage."

The legislation treats health care as a tool for coercion, instead of a tool of compassion, said Rep. David LaGrand, D-Grand Rapids.  "Today’s legislation is doubling down on a bad linkage between healthcare and employment," he said.

Sponsoring Sen. Mike Shirkey, a Clarklake Republican who negotiated changes with the Snyder administration, said he is “delighted” with the revised bill.

“This is all about trying to find more workers,” he said. “We have an obligation to review on a pretty regular basis all our policies, all our laws, all our statutes that may unintentionally result in disincentives to engage in the workplace, because every business owner I know is searching for and seeking workers.”

When Republicans moved for the bill to take immediate effect Wednesday, Democrats loudly opposed the measure. A Democratic staffer tried to run up to the rostrum at the front of the chamber, but was stopped by a sergeant and escorted from the House floor, said House GOP Spokesman Gideon D'Assandro. 

D'Assandro said the employee was fired. 

Republicans' actions against the Democratic caucus and staff were an attempt to distract from Wednesday's controversial votes, House Minority Leader Sam Singh said in a statement.

"Republicans used every rule in the book to silence the voices of House Democrats and the people we represent, and when that didn’t work, they threw out the rulebook," he said. "I am disappointed in Speaker Leonard, and I expected better."

The House Appropriations Committee Wednesday morning made changes in the Senate-passed bill that would lower the work, training or education requirement from 29 hours per week to 80 hours per month for recipients of Healthy Michigan, a government health care program for low-income residents.

Rep. Yousef Rabhi, D-Ann Arbor, effectively tried to gut the bill by arguing for an amendment that would lower the work requirement to zero. The Republican-controlled committee rejected the proposal.   

"Medicaid is not a jobs program, it is not a work program," Rabhi said. "It is a health care program.”

The changes could lead to a net state savings of between $7 million and $22 million, according to the House Fiscal Agency.

The work requirements would apply to able-bodied individuals between 19 and 62 years old. Those exempt from the requirement include pregnant women, people with a disability, caretakers of a disabled dependent or kids under six,  full-time students, recently released prisoners and the medically frail.

The House-amended bill heads back to the GOP-controlled Senate, where it is expected to pass as soon as Thursday.

The goal of the legislation is "to find more workers" in a state where many jobs go unfilled, Shirkey said, not to reduce costs. But some supporters have said the work requirement is needed to make Medicaid coverage under the federal Affordable Care Act less expensive for the state budget.

The House committee removed a Senate provision that would exempt from the work requirements any Medicaid recipients in counties with high unemployment rates. Opponents have said the provision would benefit white recipients in rural counties, but hurt minorities in cities such as Detroit and Flint, where the city unemployment rates are high, but the countywide rates are low.

State officials said the effort and cost of tracking monthly unemployment rates in every county “would have been an impossible thing to do,” Shirkey said.

“I still maintain that was the fairest way to do it,” he said. But “my focus from the beginning, was to make sure we implemented a system that wasn’t cost prohibitive.”

The revised proposal also tightens language originally designed to limit expanded Medicaid eligibility to four years. It requires recipients who want to continue coverage to complete increasingly challenging healthy behaviors and pay a five percent premium.

The modified legislation also includes a new “trigger” that would terminate the expanded Medicaid program if the state doesn't secure a federal waiver within one year of the new law. The state would give recipients a four-month warning before ending their health coverage.

The new trigger puts “Michigan’s entire Medicaid expansion under the Affordable Care Act — covering 670,000 people — at risk,” according to the Center on Budget and Policy Priorities, a liberal Washington, D.C.-based research group that opposes the measure.

Under the legislation, Medicaid recipients would lose coverage for a month if they fail to meet work or training requirements for more than three months in a 12-month period. The bill also suspends health care coverage for a year when Medicaid recipients cheat or purposefully misrepresent their work, education or training efforts. 

The implementation date for the requirement would be Jan. 1, 2020, and the requirement will cost the state about $5 million annually to administer.

A waiver from the U.S. Department of Health and Human Services is required before the state can implement the plan. Trump administration officials in January issued guidance outlining what kinds of work mandates it would accept for Medicaid.

Snyder criticized the Senate legislation in April but said last week he and Shirkey had made “a lot of progress” negotiating changes and were at the point of working out specific details.

“We have had a meeting of the minds to say let’s find that common ground,” Snyder told The Detroit News in an interview at the Mackinac Policy Conference. “It’s a complicated thing, so we’re working through that.”

The Healthy Michigan plan has “saved people’s lives” and helped people go back to work who “otherwise might not be able to be on the job,” Snyder said.

Staff Writer Jonathan Oosting contributed.


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