The Michigan Senate has passed a bill that would require able-bodied adults to complete an average of 29 hours per week of work, job training or schooling to qualify for Medicaid under a bill that cleared a Michigan legislative committee Wednesday, months after the Trump administration announced it would permit such requirements.
The bill passed with a vote of 26 yes votes and 11 no votes. It will now head to the House.
"It's not about saving money for the state. It's about securing funds for those who really need it," said the sponsor, Sen. Mike Shirkey, a Clarklake Republican who estimated that his legislation might affect 300,000 of the state's 2.5 million Medicaid recipients. Enrollment and spending on the federal-state health insurance program for low-income residents have soared under an expansion authorized by the Obama-era health law.
There would be an exemption from the work requirement for pregnant women; those receiving unemployment or disability benefits; caretakers for kids 5 and under, dependents in need of full-time care due to a disability or non-dependent incapacitated individuals; full-time students and others. People in counties where the unemployment rate is at least 8.5 percent could adhere to the "workforce engagement" rule and still receive Medicaid by actively seeking employment.
The measure would take effect in October 2019 and require able-bodied enrollees to verify each month that they are meeting the mandate. It was supported by business and conservative groups and opposed by health providers, organized labor and others.
"I fundamentally believe that the right to health care should be protected for all our citizens. That right should not be predicated on the number of hours they work," said Democratic Sen. Rebekah Warren, of Ann Arbor.
Senate GOP leadership supports the bill and is expected to hold a vote Thursday, after which the legislation would go to the GOP-controlled House, where Medicaid work bills also have been introduced.
Tanya Baker, a spokeswoman for Republican Gov. Rick Snyder — a strong advocate of an expansion program that provides Medicaid to nearly 700,000 additional adults — said his office was continuing to work with Shirkey "in a positive and collaborative way. The latest draft is still under review, but things are certainly moving forward and we're grateful for the senator's willingness to work with us."
To meet the 29-hour requirement, Medicaid recipients could work, complete education directly related to employment, participate in job or vocational training, do an internship or receive substance abuse treatment — or any combination of the options.
The Kaiser Family Foundation says three states — Arkansas, Indiana and Kentucky — have Medicaid work requirements, while seven others have requests pending before the federal government. A federal-state collaboration originally meant for poor families and severely disabled people, Medicaid has grown to become the largest government health insurance program, now covering one in five people.
The nonpartisan Senate Fiscal Agency estimates that the work requirement could affect a maximum of 1 million nonelderly, nondisabled adult Medicaid recipients but adds that estimate is "well in excess of the actual number of people" who would be impacted because of exemptions.
In January, the Trump administration said it would allow states to mandate that able-bodied Medicaid recipients work , saying that requiring work or community involvement can make a positive difference in people's lives and in their health. Wednesday's committee vote prompted Michigan's four Democratic U.S. House members to write a letter to Snyder expressing concerns that work requirements may be more punitive than helpful and urging that consideration of the proposal be postponed until the state can analyze how many Michigan residents would lose coverage.
Gilda Jacobs, president and CEO of the Michigan League for Public Policy, said the group that advocates for the poor "is all for helping people find and keep jobs, but Medicaid is keeping people healthy and able to work, not enabling residents to avoid it."
Shirkey, the sponsor of the bill, said he is open to setting the work requirement at less than 29 hours per week. He said he spoke with Snyder about the legislation on Tuesday and "this is not an obstacle that we cannot overcome."