As the federal government allows more states to implement controversial work requirements for Medicaid beneficiaries, managed care organizations are feeling the pressure to help their members find jobs or community service gigs.
There’s a lot at stake for health plans: the more members they lose because of work and reporting requirements, the bigger the squeeze on their profit margins.
Medicaid insurer WellCare Health Plans’ Kentucky subsidiary started thinking about ways to help its members maintain their eligibility for benefits when Kentucky became one of the first states to seek a waiver to impose work requirements on its Medicaid population. It came up with WellCare Works, a program meant to connect members to training and other resources to secure jobs, volunteer work or education opportunities.
The tool will help Medicaid enrollees access online job training courses and one-on-one coaching for job skills, or search for available jobs and community service opportunities. A team of advocates will work with community partners and social service agencies to help the members navigate the state work requirements and report their compliance. The program will be piloted in Lexington and Northern Kentucky first, but rolled out across the rest of the state when the work requirements go into effect on April 1.
“What we don’t want that to happen is have a member be suspended (from Medicaid) simply because they didn’t know how to engage to find community service opportunities or because they weren’t prepared and didn’t know how to get a resume or how to interview for a particular job,” said William Jones, president of WellCare of Kentucky, which serves about 400,000 of the state’s more than 1.2 million Medicaid members.
Losing coverage would only delay a member’s access to care until that member ends up in an expensive emergency room, “which is bad for the community, bad for the taxpayer and bad for the member,” he said.
Kentucky’s Medicaid waiver requires non-disabled adult beneficiaries to spend at least 80 hours a month working, training or looking for a job, volunteering, or going to school to keep their benefits. Kentucky will be the second state to implement work requirements for Medicaid, following behind Arkansas, where the rollout has been anything but smooth. Eight states have received CMS approval to require Medicaid enrollees to work or engage in other community activities to receive benefits. Most recently, the CMS approved Arizona’s waiver on Friday.
Kentucky has faced several legal challenges to its waiver. A federal judge in June blocked CMS’ initial approval, finding that the feds failed to consider the impact the waiver would have on the state Medicaid program’s primary purpose of providing medical assistance to vulnerable residents. The CMS later re-approved the waiver. The judge is still reviewing the CMS’ most recent approval.
State officials estimated that as many as 95,000 Kentucky Medicaid beneficiaries could lose eligibility over the next five years because of the requirement. Other estimates put that figure higher. Proponents of work requirements say they will help beneficiaries become self-sufficient and ultimately come off of Medicaid, which would reduce the federal and state governments growing spending on the program.
But critics argue that most beneficiaries who can work are already working; adding a requirement puts unnecessary administrative burden on the state, consumers and health insurers. And many beneficiaries who aren’t working would qualify for exemptions from the rules. They worry that some beneficiaries could be kicked out of the Medicaid program because, for example, they lack access to a computer needed to report the hours they’ve worked. Some beneficiaries who would be exempt from the requirement may have trouble navigating the exemption process.
Some of those fears are coming to life in Arkansas, where about 18,000 Arkansans have been disenrolled from Medicaid since work requirements went into effect in June. The Medicaid and CHIP Payment and Access Commission, or MACPAC, in November said that the lack of Internet access could be hindering the state from informing beneficiaries about the new requirements, and suggested that Medicaid members may need help finding and keeping a job, the Associated Press reported.
That task is falling to health insurers. Medicaid has always been a program in which members move in and out as they find jobs or lose jobs and their income changes. But that problem may only get worse with states’ work requirements, leading to wasted investments and higher healthcare spending.
“Continuity of coverage equals continuity of care,” said Jerry Vitti, CEO of Healthcare Financial Inc., a company that works with health plans to enroll their low-income members in social security programs. “These are folks with pent-up healthcare demand, who are not used to navigating the healthcare system, and putting in place resources like case managers, smoking cessation programs, and so forth are an expensive investment for the plans. The work requirements get in the way of that continuity.”
Margaret Murray, CEO of the Association for Community Affiliated Plans, which represents safety-net insurers across the U.S., said health plans invest heavily in Medicaid members in the first couple of months they enroll because of that pent-up need for services, but that investment will not pay off if the member loses eligibility. Moreover, she said making sure members can get access to job training and education, and know how to report their compliance with the work requirements, is a big investment on the part of the insurer in itself. The states aren’t helping insurers pay for it.
“We also are concerned that the health plans have to put in a lot of into member outreach, documentation and assistance, and that those costs, both personnel and IT, are not being made up in the rates, and so we’re worried that the rates may become not actuarially sound,” Murray said.
WellCare will likely roll out its WellCare Works tool to other states that impose work requirements on Medicaid beneficiaries. But its leadership stressed that the program goes beyond work requirements to tackle members’ social determinants of health and could be applied to members transitioning into the workforce from prison, for example, or foster children who have reached adulthood and are looking for jobs.
“I don’t think it is a product we would launch just in state where there is a work requirement. In any state where we have Medicaid members and it would benefit us or our members to help find volunteer opportunities, to help find work, to minimize social isolation and improve the healthcare costs, we’ll pursue that as well,” said Ben Orris, chief operating officer at WellCare of Kentucky.
While there is little evidence that having a job leads to better health, there is evidence of an association between being unemployed and having poor health, according to a review of research by the Kaiser Family Foundation.
To be sure, WellCare isn’t the only health insurer helping members find jobs in hopes of improving their health. Dayton, Ohio-based insurer CareSource has a similar program in place. Some insurers, including WellCare and AmeriHealth Caritas, also help their Medicaid beneficiaries earn their GEDs. That could put those members on the path to finding jobs with healthcare benefits.
“If we have to lose them, that’s the right reason,” Jones said. “They still have healthcare, they have a job, they are providing for their families, it’s better for them physically and mentally in terms of their health. We are 100% behind that.”