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Families USA Health Action Conference 2019 – Recap #1

From Chris Garcia, CCHCC Community Health Worker

One of the most impactful workshops I attended during Families USA was about Medicaid waivers and work requirements. We already know that waivers allow Medicaid to expand services that would not be normally covered. We see this primarily in Substance Use cases where the patient can receive care for detox and continue to receive care for counseling and other services that they might require. During the workshop we heard from representatives from Kentucky, Arkansas, and Washington DC. The one that stuck out the most was the representative from Arkansas. One of the models that they looked at was from Indiana and it was pitched as “The roadmap on how NOT to do it”. Indiana being a neighbor to Illinois really stuck out once I heard about all of the roadblocks that they face by implementing work requirements.

Illinois is facing pushes for work requirements and the system that we have in place already has its own barriers so adding more on the workload of case workers and the consumer would be a push to scare people away from Medicaid and an incentive to ignore their health care needs and go back to using Emergency Department resources for treatable and preventable conditions. Indiana has work requirements and although over 90% of recipients qualify for exemptions due to being on Social Security Disability, already being employed, and/or having dependents, the rest of the people are given more work to do in the form of tracking hours and reporting changes into a system that is not timely or easy to access. It cost the state more money to implement these work requirement than it would to provide health care coverage to that 10% not presumptively exempt. People are expected to work in order to qualify for health care coverage but it’s a twisted way to look at it when in reality health care coverage is a work support. Without your health you cannot work. We already see this in Illinois where our system also automatically drops consumers due to data-gaps. Case workers are working day in and day out on appeals for wrongful termination just as much as they are in processing new applications. I myself see this on a weekly basis. I’ve grown accustomed to appeal first and ask questions later and that is a process that not all clients can afford. They need their coverage there when they need it and can’t afford to hear when they go in for an appointment or to pick up medication that their benefits aren’t active.

As it stands now 8 states have current work requirements and 2 others are pending review/in litigation. Hearing the horror stories that come out of these states is frightening when it is so close to home as we heard from the experience Indiana is facing. We are still rebuilding our state from having no budget and Medicaid expansion has proven to work in expanding coverage and access to care. Adding barriers to the Medicaid system is a burden on the consumer and the state which financially is unsure it can afford. Instead let’s keep making Illinois an innovative state that adapts and can expand on what it has instead of cutting and taking away from those most vulnerable.