Other GOP States: "We're adding Medicaid work requirements!" Alabama: "Hold my beer."


Time: D H M S

In a way I guess this was the next "logical" step (via Jesse Cross-Call of CBPP):

Alabama, which has refused to expand Medicaid for low-income adults under the Affordable Care Act (ACA), is now proposing to make work a condition of Medicaid eligibility for very low-income parents, stating that it wants to encourage work. Its proposal, however, actually would penalize work: because Alabama hasn’t expanded its program, those who comply with the new requirements by working more hours or finding a job will raise their income above the state’s stringent Medicaid income limits, thereby losing their Medicaid coverage and likely becoming uninsured.

Specifically, Alabama proposes to require parents with Medicaid to spend at least 35 hours per week (or 20 hours if they have children under age 6) on “employment-related activities” such as work, job training, or job search to maintain their Medicaid coverage. It also proposes to shorten eligibility for what’s known as Transitional Medical Assistance (TMA), as explained below, from 12 months to six. These changes will cause a 20 percent drop in Medicaid enrollment for parents beginning next year, according to the state’s own estimates.

Aside from the stupidity, cruelty and ineffectiveness of adding work requirements to Medicaid in the first place, Cross-Call points out a slight flaw in the formula here:

...But in non-expansion states like Alabama, the rationale for work requirements makes even less sense. Alabama already has the nation’s most restrictive Medicaid eligibility rules: it offers no coverage to non-disabled, non-elderly childless adults and only covers parents with children who have incomes up to 18 percent of the poverty line, or a little more than $300 a month for a family of three.

(As an aside, the last time I checked Alabama's parental Medicaid cut-off was only 13%, not 18%, so I guess I should praise them for bumping it up 5 points?)

UPDATE: Thanks to "thinker" in the comments for clearing up the mystery: It turns out this is the same situation as ACAMedicaid expansion, which officially cuts off at 133% FPL, but effectively cuts off at 138%.

OK, so let's do the math: Let's say you're a family of three with a 10-year old child. You want to continue to qualify for Medicaid under the new rules, so you "get off your lazy butt" and "hustle" to find a full-time job of 35 hours a week at the federal minimum wage of $7.25/hour. Hey, guess what? You're earning about $1,000/month now, congratulations!

Oh, wait...now you earn about 58% of the poverty line ($20,420 for a family of 3)...more than 3x over Alabama's 18% threshold. Guess what? No Medicaid for you after all!

Am I missing something here? Am I supposed to subtract my personal exemption (and one for my child) first to calculate my MAGI?

Assuming I'm not making an obvious mistake, the only way you'd qualify is if you cut down to perhaps 12 hours a week...in which case you no longer meet the 35 hour threshold. No Medicaid for you now either!

I suppose you could work 12 hours a week and spend another 23 hours a week..."training" or "searching" for a...job...you...already have? Huh?

The article goes on to point out the other horrible provisions of the new Alabama policy, but none are less sensical and more Kafkaesque than this one.