No Justification to Time Limit Medicaid

By Jessica Gehr

The attack on health care is continuing in Washington, D.C. The Centers for Medicare and Medicaid Services (CMS), part of the federal Department of Health and Human Services, has approved state waivers that will block families from Medicaid. This follows months of Congressional efforts to undermine the program.

Medicaid is intended to provide health care to low-income people. However, many states have requested new leeway from the Trump Administration to make harmful changes to the program. For instance, some states want to limit how long beneficiaries can stay enrolled in Medicaid. Every previous administration denied this request, recognizing its dire consequences.

At least five states—Arizona, Kansas, Maine, Utah, and Wisconsin—have proposed some version of time limits. That means people who rely on Medicaid coverage to remain healthy will be kicked off the program when they reach the arbitrary limit. As a result, many will likely go uninsured.

The time limit proposals vary among states. This includes the length of time an enrollee can receive Medicaid as well as proposed work requirements. The length of time ranges from 36 months in Kansas to 60 months in Utah. Remarkably, Kansas, Utah, and Wisconsin want to limit how long an enrollee can receive Medicaid even when they’re working or otherwise meeting work requirements. In additional states with time limits, months only accrue when enrollees aren’t working or engaged in a work activity.

These policies don’t promote health; they’re just a way for states to block people from coverage. If approved by CMS, they would have a profound negative impact on Medicaid recipients and their families.

1. Time limits are based on a false assumption that workers will get health insurance from their employer.

Time limits ignore the reality of low-wage work, which is characterized by changing, unpredictable schedules; lack of paid leave; and lack of employer-provided health insurance. These policies presume that getting a job comes with affordable health care. However, that’s simply not the case for most low-wage workers. In 2017, just 14 percent of workers earning the lowest 10 percent of wages had employer-provided health insurance. If denied Medicaid, most low-wage workers will go without insurance, no matter how hard they work. This would have devastating consequences for workers and their families.

2. Time limits don’t support work.

States claim that time limits promote work and independence. In reality, they make it less likely that low-income people will be healthy enough to work. Reports from Ohio and Michigan show that Medicaid reduces health barriers to finding or keeping a job. Once someone hits their time limit, they’ll no longer have access to the health and mental health care they need, leading to worse health outcomes and interfering with their ability to work.

3. Time limits discourage preventive care.

Time limits deter healthy people from enrolling in Medicaid. Families will be forced to “bank” their limited months and not enroll until they experience a major health issue. This can prevent them from getting crucial preventive care, early treatment for new illnesses, or consistent treatment of chronic diseases.

Without coverage, workers will start delaying or forgoing visits to the doctor. This can have deadly consequences. One study found that Medicaid disenrollment is associated with delays in diagnosis and treatment. Many breast cancer diagnoses came at later stages. Time limits can quite literally be the difference between life and death.

4. Time limiting parents’ coverage has negative implications for children.

Placing a time limit on parents’ coverage will also have negative implications for their children’s coverage and health. Research has repeatedly demonstrated that children are more likely to have health insurance when their parents have health insurance. Additionally, when parents have insurance, their children are more likely to receive annual check-ups and well-child visits. Limiting parents’ Medicaid access will undermine children’s healthy development and academic success.

5. Time limits will be even more damaging during economic downturns.

In its current structure, Medicaid responds to people’s needs as well as the economy. However, if time limits are approved, people won’t have a medical safety net left during the next economic crisis.

Temporary Assistance for Needy Families (TANF) demonstrated the danger of time limits during the Great Recession.  Because TANF has a federal 60-month time limit, with many states imposing shorter limits, the program couldn’t respond to the sharp increase in need. While families grappled with job loss and struggled to meet basic needs, TANF failed to react as a countercyclical measure for low-income households.

If these waivers are approved, Medicaid will experience the same problem during the next economic downturn. Families will be forced to choose between going uninsured now (saving their Medicaid enrollment time for when personal or economic crisis hits) or using their months now to access preventive care and hoping for the best once their time has expired.

States can’t legitimately argue that time limits fulfill any goal of Medicaid. These waiver requests are about kicking people off the program. If time limits are approved, the consequences for the poorest families will be harsh and unprecedented. For many people, time-limit policies could be the difference between life and death. CMS should reject these immoral, mean-spirited waivers.