CMS continues to pursue work requirements despite historic unemployment and pandemic 

By Suzanne Wikle

It’s late in 2020, and it’s been a long year. Over 8 million people in the United States have contracted COVID-19 and more than 220,000 have died from it.  Over 57 million people have filed for unemployment, upwards of 10 million people have lost health insurance through their employer, and an estimated 8 million more people are living in poverty today than in May.

The Centers for Medicare and Medicaid Services (CMS) should be using this time to connect people with health insurance by creating a COVID-19 special enrollment period, conducting outreach and enrollment education about the availability of Medicaid and marketplace coverage to those losing employment, or by encouraging the 12 remaining states to adopt Medicaid expansion. Instead, CMS officials are doubling down on their ongoing efforts to restrict people’s access to Medicaid by approving new work reporting requirements in Georgia and Nebraska.

Work reporting requirements for programs that support basic needs are always a bad idea. They are fundamentally racist, create red tape and bureaucratic hurdles, and don’t achieve their stated aim of increasing employment. All they do is cause harm and cost a lot of money to administer. Approving work reporting requirements for Medicaid during a global pandemic and a period of historic unemployment is a new low for CMS. But it appears CMS officials will not let the crises of 2020 deter them from standing between people who are uninsured and affordable health insurance.

240,000 Georgians don’t have health insurance because state policymakers have chosen not to expand Medicaid. Instead, Georgia is planning to create enormous administrative bureaucracy and forgo millions in federal dollars to create a new program. Under the new program, uninsured Georgians below the poverty level will be able to enroll in Medicaid only if they submit paperwork documenting at least 80 hours a month spent working or meeting another qualifying activity.

To be clear, CMS is allowing Georgia to base eligibility for health insurance on whether people complete activities (work, applying for jobs, etc.) that are literally dangerous to do right now because of the COVID-19 pandemic. Medicaid eligibility should never be tied to employment; doing so during a global pandemic is incomprehensible. Instead, Georgia should join 39 other states and D.C. by expanding Medicaid, which has succeeded at lowering uninsurance rates, reducing health disparities, and improving people’s health.

In Nebraska, voters approved a ballot initiative for Medicaid expansion in 2018. Voters recognized that Medicaid expansion is a win for people with low incomes, public health, state budgets, and rural hospitals alike. Since then, however, the state has dragged its heels to implement expansion–although enrollment recently opened on October 1. Despite the ballot initiative’s language barring the state from placing enrollment hurdles into the application process, the state asked CMS for permission to do just that by requesting a work reporting requirement on certain Medicaid coverage. Following its actions in Georgia, CMS approved Nebraska’s request to implement a work reporting requirement for people in the expansion population to access certain health care (dental, vision, and over-the-counter medications).  All this does is create paperwork and confusion, while limiting access to critical health services.

Georgians and Nebraskans deserve better. Everyone should have access to health care, regardless of which state you live in or whether or not you are able to navigate a web of red tape. CMS should pursue this goal and do everything in its power to increase access to health insurance through successful programs including Medicaid expansion. Instead, CMS officials continue to promote their ideological agenda to allow states to limit access to Medicaid.