Last fall, Mississippi submitted a Section 1115 Medicaid Demonstration Wavier seeking to establish a Medicaid work requirement that would make it harder for thousands of Mississippians to enroll in coverage and access needed healthcare. Even CMS recognized the serious consequences the waiver could have in a state like Mississippi that did not expand Medicaid. In an attempt to expedite approval for the state's waiver, Mississippi recently submitted a revised application that provides an additional 12 months of benefits. While this sound like a positive change, it does NOT solve the issues with the initial waiver.
CMS Administrator Seema Verma recently stated that any non-expansion state seeking to impose work requirements would need to develop a plan to address the "subsidy cliff" individuals will experience if they attempt to meet a work requirement. The "subsidy cliff" refers to a situation that many will find themselves in, earning too much to qualify for Medicaid but not enough to qualify for financial assistance on the Affordable Care Act's health insurance marketplaces. Out of concern for this subsidy cliff, CMS rejected the state of Kansas's Medicaid Section 1115 waiver application seeking to impose work requirements, since the state has not expanded Medicaid. Mississippi's revised waiver application attempts to address the subsidy cliff by including an additional 12 months of Medicaid.
Key points:
Providing an additional 12 months of benefits postpones, rather than removes, the harmful "subsidy cliff" that the work requirement will place Mississippi Medicaid enrollees in of earning too much to qualify for Medicaid but too little to qualify for financial assistance in the ACA's marketplaces.
Ultimately, the revised application does not protect Mississippi Medicaid enrollees from experiencing a harmful loss of health coverage even when they're complying with the work requirement.
Health care needs can arise at any time, whether they're immunizations, doctor's visits, surgeries or medical emergencies. Cutting off Medicaid after the additional 12 months for individuals who are meeting all eligibility requirements is an arbitrary and punitive policy that will unnecessarily put Mississippians at risk of medical debt or bankruptcy.
Roy Mitchell, Executive Director of the Mississippi Health Advocacy Program, stated, "It is hard to understand how taking away health coverage from thousands of Mississippians who aren't offered health insurance through their jobs and are otherwise meeting the Mississippi Division of Medicaid's proposed work requirements fulfills Medicaid's stated goals of "improvement of health outcomes" and "promotion of financial stability."