Boost work: Keep Medicaid accessible

Complicating Iowans’ ability to get checkups and the medications they need will not improve workforce participation.

Iowa’s Medicaid program carries two major purposes. First, Medicaid provides medical care for the elderly; in fact, 44 percent of Medicaid spending goes for long-term services and supports for seniors.[1] About half of Iowa nursing home residents benefit from Medicaid.[2]

Second, Medicaid covers thousands of Iowans working in low-wage jobs with no health insurance benefits and to thousands of others who have a disability that prevents them from working. Nearly half of all Medicaid recipients in Iowa are children.[3]

The data show that Medicaid is an important work support. Most non-elderly adult Medicaid enrollees in Iowa work — 72 percent — and 87 percent live in a working family.[4]

Among Medicaid enrollees in Iowa, larger shares of African-American and Latino enrollees are working than whites. One-third of Iowa working Medicaid enrollees work in smaller companies, which likely do not provide employer-sponsored insurance. It might surprise Iowans to know the largest group of Iowa workers receiving Medicaid work in elementary and secondary schools.[5]

Imposing new requirements for Medicaid would complicate health-care access for low-wage workers, children, veterans, older Iowans and Iowans with disabilities. It would not improve workforce participation.

Contrary to some political claims, studies in case after case show the main impact of extra Medicaid requirements is not better jobs,[6] but disenrollment in Medicaid, worse health outcomes, less access to care, and financial insecurity.[7] Rather than promoting good health that is important for employment and productivity, added Medicaid eligibility requirements undermine the goal of encouraging work.

If policy makers’ goal is to increase workforce participation, more practical approaches exist in expanding the state Earned Income Tax Credit and Child Care Assistance eligibility.

Not only do new Medicaid requirements fail to encourage work, but they make sustaining coverage difficult for people who are exempt from work, such as Iowans with disabilities, who may face obstacles in documentation and verification. Workers with variable hours, particularly in food service, retail, and seasonal jobs, could face similar issues.

Many working Medicaid enrollees work full time, but their low annual wages still quality them for Medicaid.[8] Rural communities rely heavily on Medicaid; disenrollment could harm rural hospitals and restrict access to care for children, the elderly, and veterans.[9]

It makes no sense to restrict access to health care for Iowans who are working or are exempt due to age or disability status.

 

[1] Steve Eiken, Kate Sredl, Brian Burwell & Angie Amos, “Medicaid Expenditures for Long-Term Services and Supports in FY 2016.” Table 31. Iowa LTSS Percentage Trends. https://www.medicaid.gov/medicaid/ltss/downloads/reports-and-evaluations/ltssexpenditures2016.pdf

[2] Kaiser Family Foundation, “Medicaid’s Role in Nursing Home Care.” Table 1: Medicaid’s Role in Nursing Home Care, by State.  June 2017. https://www.kff.org/infographic/medicaids-role-in-nursing-home-care/

[3] American Community Survey, “Health Insurance Coverage Status and type of Coverage by State and Age for All People: 2017.” Table H105. September 2018. U.S. Census Bureau. https://www.census.gov/data/tables/time-series/demo/income-poverty/cps-hi.html

[4] Rachel Garfield, Robin Rudowitz, & Anthony Damico, “Understanding the Intersection of Medicaid and Work.” January 2018. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work/

[5] Ibid.

[6] LaDonna Pavetti, “Work Requirements Don’t Cut Poverty, Evidence Shows.” June 2016. Center on Budget and Policy Priorities.  https://www.cbpp.org/research/poverty-and-inequality/work-requirements-dont-cut-poverty-evidence-shows

[7] Hannah Katch, “Medicaid Work Requirements Will Harm Families, Including Workers.” February 2018. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/medicaid-work-requirements-will-harm-families-including-workers

[8] Ibid.

[9] Center on Budget and Policy Priorities, “How Medicaid Work Requirements Will Harm Rural Residents – And Communities.” August 2018. https://www.cbpp.org/research/health/how-medicaid-work-requirements-will-harm-rural-residents-and-communities

 

Natalie Veldhouse is a research associate for the nonpartisan Iowa Policy Project. nveldhouse@iowapolicyproject.org

SNAP changes: Ignoring what works

EITC and child care more effective than drug tests and work requirements

Work requirements for public assistance seem to be all the rage — at both the national and state levels — when other policies would do more to encourage and support work.

President Trump signed an executive order April 10 enhancing enforcement of federal public assistance work requirement laws, evaluation of program effectiveness, and consolidation or elimination of “ineffective” programs.[1] The Trump administration also is considering drug tests for SNAP (Food Stamp) recipients.[2]

Similar legislation in Iowa (Senate File 2370) intended to expand regulations on and further monitor recipients of public assistance in Iowa, but appears to have stalled as the 2018 session nears an end. This included implementing work requirements, drug testing, quarterly reviews of eligibility, and a one-year residency requirement.[3]

The Farm Bill draft[4] released April 12 would reduce or eliminate SNAP benefits for 1 million households, or 2 million recipients, according to the Center on Budget and Policy Priorities (CBPP). Work requirements would force able-bodied adults without dependents to prove every month that they work or participate in a training program 20 hours per week. Severe sanctions for noncompliance would cut off benefits for one year the first time — three years the second.[5]

Recent research found recipients under work requirements for Temporary Assistance to Needy Families (TANF) continued to live below the federal poverty level, and that small increases in employment diminished over time and did not result in stable employment in most cases.[6] In the long term, programs that provide training, skill building, and educational opportunities to recipients are shown to be more successful than only implementing work requirements.[7]

Evidence shows that people in SNAP households who can work do work. More than 80 percent work during the year before or after receiving benefits.[8]

Drug testing public assistance recipients has proven to be costly and frivolous. States that have implemented drug testing found that applicants have lower drug usage rates than the general population. The state of Missouri spent $336,297 in 2015 to test 293 of 31,336 TANF applicants and found only 38 positive results.[9]

Eleven percent of Iowans received public assistance in February of 2018.[10] Already, able-bodied adult without dependents have work requirements to receive SNAP in the state of Iowa.[11]

By contrast, the Earned Income Tax Credit and Child Care Assistance (CCA) are policies that are effective in encouraging work. In addition, Iowa could make changes in work support programs, such as CCA,[12] to reduce what are known as “cliff effects” — when families with a pay raise or a new job are faced with a net loss because a reduction in benefits exceeds the new income.

Policies that support working families, not drug testing and work requirements, would do more to encourage work, raise family incomes, and boost local economies.

 

[1] The White House, “Executive Order Reducing Poverty in America by Promoting Opportunity and Economic Mobility.” April 2018. https://www.whitehouse.gov/presidential-actions/executive-order-reducing-poverty-america-promoting-opportunity-economic-mobility/

[2] Associated Press, “Drug testing plan considered for some food stamp recipients.” April 2018. https://www.apnews.com/6f5adff5efeb4f9a9075f76bf9cf5572

[3] IA Legis, “Senate File 2370” February 2018. https://www.legis.iowa.gov/legislation/BillBook?ga=87&ba=SF2370

[4] House Agriculture Committee “H.R. 2: the Agriculture and Nutrition Act of 2018.” April 2018. 115th Congress. https://agriculture.house.gov/uploadedfiles/agriculture_and_nutrition_act_of_2018.pdf

[5] Center on Budget and Policy Priorities, “Chairman Conaway’s Farm Bill Would Increase Food Insecurity and Hardship.” April 2018. https://www.cbpp.org/research/food-assistance/chairman-conaways-farm-bill-would-increase-food-insecurity-and-hardship#_ftn1

[6] Urban Institute, “Work Requirements in Social Safety Net Programs.” December 2017. https://www.urban.org/sites/default/files/publication/95566/work-requirements-in-social-safety-net-programs.pdf

[7] Center on Budget and Policy Priorities, “Work Requirements Don’t Cut Poverty, Evidence Shows.” June 2016. https://www.cbpp.org/research/poverty-and-inequality/work-requirements-dont-cut-poverty-evidence-shows

[8] Center on Budget and Policy Priorities, “Making SNAP Work Requirements Harsher Will Not Improve Outcomes for Low-Income People.” March 2018. https://www.cbpp.org/research/food-assistance/making-snap-work-requirements-harsher-will-not-improve-outcomes-for-low

[9] Center on Law and Social Policy, “Drug Testing SNAP Applicants is Ineffective and Perpetuates Stereotypes.” July 2017. https://www.clasp.org/sites/default/files/publications/2017/08/Drug-testing-SNAP-Applicants-is-Ineffective-Perpetuates-Stereotypes.pdf

[10] Iowa Department of Human Services, “Food Assistance Report Series F-1.” March 2018. http://publications.iowa.gov/27299/1/FA-F1-2016%202018-03.pdf

[11] Iowa Department of Human Services, “ABAWD Letter.” September 2017. https://dhs.iowa.gov/sites/default/files/470-3967.pdf

[12] Peter S. Fisher and Lily French, Iowa Policy Project: Reducing Cliff Effects in Iowa Child Care Assistance, March 2014. https://www.iowapolicyproject.org/2014docs/140313-CCA-cliffs.pdf

 

2018-NV-6w_3497(1)Natalie Veldhouse is a research associate at the nonpartisan Iowa Policy Project.

nveldhouse@iowapolicyproject.org