How work requirements for Medicaid could affect Virginians

Axios

2 days ago

The U.S. Senate is considering a massive budget bill, passed by House Republicans, that seeks to save money by adding work requirements to Medicaid.
The big picture: When Virginia tried adding similar work requirements years ago, the Department of Medical Assistance Services, which oversees the state's Medicaid program, said about 50,000 people would lose coverage.
But that number would likely to be higher now since more Virginians are enrolled than in 2018.
Rough estimates from the Center on Budget and Policy Priorities, for example, show nearly 200,000 Virginians losing coverage, including those who work or qualify for an exemption.
Updated numbers won't be available until "the end of 2025 at the earliest," since they depend on federal guidance, DMAS spokesperson Kedra Keith tells Axios.
State of play: The proposed bill requires states to deny or end coverage to anyone aged 19 to 64 who isn't working at least 80 hours per month, with some exemptions, starting Dec. 31, 2026.
The accelerated timeline could pose administrative challenges to the states, which would be tasked with setting up expensive employment verification systems within a year and a half.
Flashback: When Attorney General Jason Miyares introduced a nearly identical bill in 2018 as a state delegate, DMAS told lawmakers it could take two years to get the work requirements up and running.
DMAS estimated that adding staff, changing systems, and gathering data to meet those requirements would cost more than $23 million. It would also lead to an estimated two-year loss of revenue that would offset the "savings of reduced coverage."
Between the lines: These work requirements never went into effect because former Democratic Gov. Ralph Northam stopped them from moving forward in 2019, frustrating state Republicans.
Friction point: The White House and some Republicans say they're rooting out fraud and avoiding subsidizing adults who "choose" not to work.
But critics like Freddy Mejia, policy director for progressive policy group The Commonwealth Institute for Fiscal Analysis, tell Axios the changes could lead to accidental coverage loss.
"Historically, qualifying individuals have been kicked off coverage simply due to technology literacy and language barriers that make it difficult to keep up with paperwork requirements," said Mejia.
By the numbers: There's little evidence that people are mooching off Medicaid, reports Axios' Emily Peck.
Nationwide, 96% of adults with Medicaid work full or part time, take care of family, are disabled, attend school, or are retired, per an analysis of census data by the CBPP.
2% could not find work and another 2% are in an "other" category.
What we're watching: If the bill passes Congress, states could lose funding if they don't adopt the requirement — and Virginia has a trigger law automatically ending expanded Medicaid coverage if federal funding drops below 90%.