Gretchen Whitmer asks to stop Michigan Medicaid work rules; 80,000 at risk

With 80,000 Michiganders at risk of losing health care coverage in the coming months, Gov. Gretchen Whitmer asked a federal court Tuesday to suspend the program that requires Medicaid beneficiaries to prove to the state they’re working — or give a documented reason for why they are not — as a condition of coverage.

Since Jan. 1, more than 238,000 Michiganders ages 19 to 62 have been required to work at least 80 hours a month or provide a legitimate reason why they are not working, such as being pregnant or enrolled in school. 

With the first of the monthly reports due Saturday, roughly 80,000 people (or 1 in 3 Medicaid recipients the state has deemed able to work) have not yet filed documents on their work status, according to a statement released Tuesday by Whitmer’s office. 

That puts them one step closer to losing health coverage under Healthy Michigan, the state’s expanded Medicaid program.  Beneficiaries who fail to properly document their activities for three months in a 12-month period can lose coverage.

Related:

• ​ Five things to know about Michigan’s Medicaid work rules
• Michigan the latest to roll out Medicaid work rules. Can it avoid pitfalls?
• A steady job can give you health coverage, but can health coverage help you work?

For now, Michigan has the nation’s only active program requiring those who get state Medicaid expansion coverage to work for those benefits, engage in activities like school or job training, or prove they are otherwise exempt from the rules. 

This month, the U.S. Court of Appeals for the District of Columbia upheld a lower court’s order striking down a work rules program in Arkansas. In a unanimous decision, the appeals court found that the imposition of work rules do not fit within the primary objective of the Medicaid Act, which is to provide health care coverage to the poor.

That decision, according to Whitmer’s office, means the Michigan program is unlawful, too, according to the Tuesday statement.

“This opinion leaves little doubt that Michigan’s Medicaid work requirements are also unlawful…. If there was any doubt about the future of work requirements then, that doubt is now erased,” it read.

On Tuesday, the Michigan Department of Health and Human Services asked U.S. District Court Judge James Boasberg in Washington, D.C., to suspend the program as part of a case before him, Young v. Azar. In it, four Michigan women argue the state’s Medicaid work requirements are politically motivated and run counter to the mission of Medicaid and the 2010 Affordable Care Act, which established Healthy Michigan as part of expanded Medicaid.

The Trump administration opened the door to work rules in 2018 when it issued guidelines that allowed states to compel working age, able-bodied Medicaid recipients to work or meet other requirements to receive benefits. 

The first attempt went badly in Arkansas, where more than 18,000 people lost Medicaid benefits under rules similar to those in Michigan. A report in the New England Journal of Medicine concluded that half of Arkansas’s Medicaid recipients were confused, incorrectly believing they did not meet the work requirements. Others didn’t have Internet access to meet that state’s reporting requirements. (Arkansas, unlike Michigan, only allowed online filing of work documentation.)

MDHHS director Robert Gordon had worried about a similar scenario in Michigan.

“We remain concerned about loss of coverage,” department spokesman Bob Wheaton said Tuesday. “We still think there will be more than 100,000 people losing coverage in 2020 if the law remains in effect. This is only one month of data and there are many people who will come onto the program throughout the year that will not comply.”

Whitmer also sent a message to the Legislature Tuesday, asking lawmakers to immediately suspend the program, but it’s not likely to find a sympathetic ear in the Republican-led bodies that passed the work rules under a GOP governor, Rick Snyder, in 2018.

Some consumer advocates and attorneys have said those subject to the rules are often already working and that giving people coverage helps them remain healthy so they can continue holding down a job. 

While Whitmer and Gordon oppose work rules, Michigan’s Legislature has given them little choice but to enforce them. Senate Majority Leader Mike Shirkey, a Clarklake Republican who sponsored the 2018 work rule law and co-sponsored a 2019 law to ease compliance reporting rules, has said implementation “can’t happen fast enough.”

Amber McCann, Shirkey’s spokeswoman, told Bridge Magazine on Tuesday his support for the program “has not wavered” and the Senate has no intention of backing off the work requirements 

“He believes fostering a path of independence and supporting an individual in pursuit of his or her highest level of personal productivity is essential to the health and productivity of our entire population,” McCann said.

Others support the rules, too, including the Michigan Chamber of Commerce, which said the rules are likely to boost the state’s employment ranks and shrink a “workforce shortage and talent gap.”

Lindsay Killen, who writes about health policy for the Mackinac Center for Public Policy, a Midland-based nonprofit advocating for free markets and limited government, noted the court decision this month in Washington did not directly rule on the Michigan program. 

“As no courts, and especially not the Michigan Supreme Court or the United States Supreme Court, have ruled yet that these requirements are unconstitutional, we believe strongly that [Michigan] must continue to move forward,” Killen told Bridge on Monday.