Nate Crippes: Medicaid red tape increases risk to public health

(AP Photo/Rick Bowmer, File) In this June 27, 2017, photo, protesters block a street during a protest against the Republican bill in the U.S. Senate to replace President Barack Obama's health care law, in Salt Lake City. The Trump administration will allow Medicaid expansion with a work requirement in Utah, a decision that came Dec. 23, despite courts taking a dim view of the requirement in other states.

Since the beginning of this year, many Medicaid recipients have been required to climb a mountain of paperwork in order to keep their health insurance, including a rule that they must apply for 48 jobs and report each of those applications to the state.

Concerns about these work requirements for Medicaid expansion beneficiaries are not new. However, those concerns are now amplified amid the current COVID-19 pandemic. While Gov. Gary Herbert and the Utah Department of Health might not share our concerns generally, they should agree that now is not a time to ask individuals to risk their health, the health of others or their health care coverage to satisfy a requirement that is unlikely to achieve the desired result.

Also, under the Families First Coronavirus Response Act, states can receive enhanced federal matching funds. However, our state might not be eligible to receive them with the work requirement in place, forgoing federal funds to help with this crisis.

As advocates have noted over the last several months (or years), many individuals in the expansion population do not have access to the internet. These individuals have to rely on libraries and other government offices to use the internet to make the 48 job contacts they’ll need to comply.

Currently, most libraries are closed, and several counties have stay at home orders. We should not be asking these individuals to go out and find a public place to complete a work reporting requirement.

Moreover, an individual who is subject to the work requirement might get COVID-19, with symptoms or not. This person should not be going out. Like all of us, Medicaid enrollees should be practicing social distancing but, at this point, their coverage could be impacted if they limit their job search by staying home.

Further, the department’s own estimates suggest thousands could lose coverage because of the work requirement. Even individuals who qualify for an exemption will fall through the cracks due to the barriers to proving eligibility.

Advocates have been calling attention to these potential coverage losses for years, but the danger is greatly heightened at this moment when we are facing a pandemic with no end in sight.

Public health officials suggest this could last through the summer, straining our system up to a year or longer. Individuals in the expansion population could see coverage loss as soon as May of this year.

As a state, we want people to get medical care for COVID-19 symptoms, not avoid seeking testing and treatment because of a lack of coverage.

Finally, there has been much reporting on how hard workers will be hit by this crisis, so we can only assume we will face a job shortage for the next several months. Thus, it is highly unlikely making the job contacts will actually lead to gainful employment.

There are many policy changes the state can make to improve access to care, encourage people to get covered and address this pandemic crisis head-on. Utah needs to remove paperwork barriers, eliminate all cost-sharing, allow presumptive eligibility and actively promote enrollment in public insurance programs.

At a time when elected officials are asking us to come together to support our neighbors, we ask them to do the same. We call on state officials to stop the Medicaid expansion work requirement and eliminate other coverage barriers.

At this time when we are uniting to combat the COVID-19 pandemic, every effort should be made to bring people in to the health care system. We should not be upholding bureaucratic barriers to keep them out.

Nate Crippes

Nate Crippes is an attorney with the Disability Law Center, Salt Lake City.