EDITORS/NEWS DIRECTORS:
Across the nation, states face an immense task and high costs to prepare for the Jan. 1 kickoff of new Medicaid work and eligibility requirements.
A law signed last year by President Donald Trump will require some adult Medicaid participants to show they are working, volunteering or taking classes. And they will face eligibility reviews every six months, instead of annually.
To carry out the new requirements, many states first will have to spend millions of dollars improving their computer systems.
Congress has provided $200 million to help states implement the new requirements. The first of that money already has begun flowing to states. But the tab for the needed technology improvements and additional staff is likely to exceed $1 billion, according to an Associated Press analysis of budget projections in more than 25 states. That extra cost will be borne by a mixture of federal and state tax dollars.
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READ AP’S STORY
Trump’s Medicaid work mandates are meant to save money. But first states will have to spend millions
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READ THE LAW
The Medicaid work and eligibility requirements are contained in House Resolution 1, signed into law July 4 by Trump.
The full text of the law can be found here.
It's a big bill — as Trump is fond of saying — so to read about the work requirements search for "SEC. 71119" entitled “Requirement for States to Establish Medicaid Community Engagement Requirements for Certain Individuals.”
WHAT TO KNOW ABOUT THE WORK MANDATE
The work requirement applies only in states that have expanded Medicaid coverage to adults ages 19 through 64, without young children, whose incomes are above the typical eligibility cutoff. Georgia is the only state that already has a work requirement for some Medicaid recipients.
The requirement does not apply in Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas and Wyoming.
The “community engagement” requirement, as it's called in the law, can be met by working or doing community service at least 80 hours a month, or by being enrolled at least half-time as a student.
There are number of exceptions, including for parents or guardians of children younger than age 14 or those with disabilities. Some of the others exempt from the requirement include people with substance use or mental disorders; people with physical, intellectual or development disabilities; the “medically frail” and those with serious or complex medical conditions.
HOW MUCH ARE STATES SPENDING?
Projected costs vary to make the technological updates necessary to track the new work and eligibility requirements and to hire additional workers to handle the extra administrative load. Some states have detailed cost projections, others only general numbers, and others are still calculating the costs.
Here are some examples of projected costs to comply with the Medicaid changes, with totals that include both federal and state funds:
Arizona: $65.1 million to make technology changes, hire 150 additional staff, conduct more frequent eligibility redeterminations and meet other administrative requirements.
Colorado: $51.2 million to verify work qualifications, conduct outreach to Medicaid participants about the eligibility changes, accommodate an expected increase in appeals, update technology and increase funding for county administration.
Hawaii: $60 million for technology improvements to the eligibility system and additional staff.
Kentucky: $46.6 million for information system changes needed to meet the work requirements and eligibility redeterminations, potentially including additional staff.
Maryland: $32.5 million to implement the Medicaid changes.
Massachusetts: $29.8 million for data system improvements, outreach efforts to Medicaid participants and additional staff to handle eligibility determinations.
Missouri: $59.9 million to make technological improvements to the eligibility and enrollment system, improve interactive customer platforms such as chatbots, develop new ways of verifying information, and hire more than 120 additional workers.
New Mexico: $45.1 million for information technology system improvements, to provide notices to Medicaid participants and to hire additional employees.
Rhode Island: $27 million for technology system improvements and additional staff or contractors.
Washington: $80.7 million for information technology system changes, eligibility changes and additional staffing.
West Virginia: $11.4 million to implement the work and eligibility system requirements.
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CONSIDER THESE REPORTING THREADS AND TIPS
— How much does your state expect to spend to implement the Medicaid work and eligibility requirements? Talk to officials at the state agency that oversees Medicaid. Talk also with state lawmakers on committees responsible for preparing state budgets
— How old is your state's current Medicaid eligibility and enrollment system? Does your state already have a contract with a private-sector vendor to help maintain it? What sort of technical work is needed to bring it up to speed? Your state's Medicaid agency should know this.
— How many Medicaid recipients may have to comply with work requirements in your state? Your state Medicaid officials may have two figures — the total number of adults in the Medicaid expansion group subject to the new law, and a smaller estimate of how many they think might have to comply after accounting for exemptions.
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READ ADDITIONAL AP COVERAGE ON MEDICAID WORK REQUIREMENTS
Nebraska plans to be the first state to implement Trump’s new Medicaid work requirements
Medicaid, food aid recipients worry about safety net cuts in bill sent to Trump
Georgia’s experience raises red flags for Medicaid work requirement moving through Congress
Work requirements could transform Medicaid and food aid under US budget bill
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