As noted in the St. Louis Post-Dispatch and other media, the State of Missouri needs $67 million in extra money to implement work requirement verification in MO HealthNet, a.k.a. Medicaid. [ ‘Big Beautiful Bill’ to cost Missouri $67M more for Medicaid ] Much of that money will be used for computer upgrades, a constant issue in Jefferson City where they still try to make progress on the IT modernization program ordered by the governor – Matt Blunt.
Alas, $67 million will be just the first cup in the bucket. Records from other states enforcing work requirements are not encouraging. In Georgia, per Pro Publica, the state spent $2.00 overseeing work requirements for each dollar spent on health care. [ Georgia’s Medicaid Work Requirement Program Spent Twice as Much on Administrative Costs as on Health Care, GAO Says — ProPublica ] Arkansas had issues with their first run at work requirements, so, of course, that state’s MAGA Governor, Sarah Huckabee Sanders, insists that they fail again.
So, expect Missouri to spend probably $150 million a year getting eligible folks kicked-off Medicaid.
And, their will be a lot of work involved…
Work for working folks on Medicaid Despite the best “intentions” of the Republican party to make record keeping simple, every person (and they may be 200,000 or more Missourians damned to work requirement reporting) will have to keep detailed personal records. Even if they can submit “paperwork” electronically they’ll need to maintain copies of every paystub and probably every work schedule to prove their compliance when they’re randomly audited or, just as likely, when the state screws up their file. Remember, the responsibility for compliance rests on the covered worker and not the state.
Plus, another wrinkle: many employers – especially those with large numbers of lower wage employees – no longer issue checks with paystubs. They do electronic transfer or debit card reloading. Instead of paystubs, many get referred to a website where they can log-on to see their status and numbers. Covered workers will need to figure out how to capture and preserve that data. (Again, the employer cannot be compelled to help verify the employee’s data.)
Work for state employees Again, assuming just 200,000 records to review each month and needing just one hour per covered person to process things, that’s 1,180 state employees working full time to keep up. And, keep up they must. Failure to process the reports in a timely manner will mean someone may not be covered when they enter the emergency room with chest pains.
Work for the courts Expect both state and federal judges to quickly be involved. Too bad the State of Missouri has a miserable track record in cases like these. Children Services got stomped in federal court tears ago. More recently the food stamp program took a major hit – which Missouri still hasn’t obeyed. When lives are literally on the line the courts must demand that each participant get served fairly and offered expedited due process. Don’t hold your breath on that.
To sum it up, work requirements for working folk on Medicaid sound good at MAGA rallies. In practice they’re expensive, they create artificial ways for people to get frozen out of health care, and, things quickly get messy.
So of course Missouri will charge ahead.
Glenn Koenen