In summary

The Trump administration said it’s OK to require Medicaid recipients to work. A state senator would bar California from adopting such a mandate.

Update: The Legislature passed, and Gov. Jerry Brown signed, SB 1108.

Since the Trump administration said in January that states could require Medicaid recipients to work if they want to continue receiving the benefit, three states have signed on: Kentucky, Indiana and Arkansas. Many others are considering it.

California, of course, is walking a different path. State Sen. Ed Hernandez (D-West Covina) is floating a bill, SB 1108, to ban work requirements for Medi-Cal recipients. Medi-Cal is California’s version of Medicaid, the national health care program for the poor.

Hernandez called the federal work-requirement idea “backwards” when introducing his bill. “Now is the time to focus all efforts on covering more people,” he said, “not less.”

Proponents of the work requirement say it can save money and make recipients accountable for receiving benefits. The whole point of requiring work for non-disabled adults, according to federal guidance, is to promote recipients’ well-being and increase their self-sufficiency.

Critics argue it won’t reach any of those goals and, in fact, might actually cost states money. Erecting a work wall, they say, also would discourage people from getting Medicaid and drop many people who need it.  

 “I’m not sure why adding a work requirement would promote well-being,” said Nadereh Pourat, director of research at the UCLA Center for Health Policy Research. “The reality is, the great majority of Medicaid recipients are children or seniors—or they’re part of working families. We can’t assume people who get Medicaid are just sitting on their hands.”

In California, most of the working-age poor on Medi-Cal already do have jobs. According to a California HealthCare Foundation report based on 2016 data, children and seniors make up the vast majority of Medi-Cal recipients. Only about a third are working-age, non-disabled adults.

The majority of those adults, 62% of them, work. Among those not working, almost all (82%) were ill, caring for an ailing family member or going to school.

Who’s left? The report said 324,000 Californians who didn’t work and were eligible to work were receiving Medi-Cal benefits. That’s about 2.4% of the 13.5 million on Medi-Cal.

If a work requirement would lift those people out of poverty and off Medi-Cal, that would save the state money, right?

That’s a pipe dream, according to Anthony Wright, executive director of the Sacramento-based Health Access, a nonprofit health advocacy group. Wright said a work requirement won’t make jobs appear.

The real way the work-for-Medicaid plan saves money is by cutting back on the number of people who receive benefits, he said. Imposing a lot more paperwork and eligibility requirements would do the trick, he said.

“This will have an impact because of the paperwork and administrative barriers being put up to get coverage. People will fall off coverage as a result,” Wright said. “That’s the hidden agenda.

“Those [work-for-Medicaid] rules would marginalize Medi-Cal as a welfare program, rather than see it as a safety net for all of us,” he said.

The Hernandez bill doesn’t defy federal guidance the same way California’s cannabis and sanctuary laws do—adoption of a Medicaid work requirement is a choice. But it sends a message.

Hernandez has said he’s hoping other states might follow California’s lead. And resistance did crop up in Minnesota, where one legislator sent a message similar to California’s:

Democratic Sen. Tony Lourey recently proposed an amendment to a Republican-backed work-for-Medicaid measure in Minnesota, one that the GOP-controlled Legislature there quickly voted down. It would have required that lawmakers lose their state-funded health care benefits unless they work with some of the people affected by the legislation.

That is, the amendment said legislators must put in some time at, say, the county human services agency when the Legislature was not in session, or they’d lose their state health coverage.

The California bill already has passed the Senate Health committee, which Hernandez chairs, and has been given priority status by the influential Latino caucus. It has no organized opposition and is expected to sail through the Legislature.

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