He built Michigan’s Medicaid work requirement system. Now he’s warning other states

By Kate Wells Michigan Populace KFF Soundness News It was March and Robert Gordon was about to kick various people off wellbeing insurance As the Michigan state fitness director he had spent the past year and several million in state tax dollars trying to avoid that very thing Gordon was a Democrat a veteran of the Obama administration and he did not want people to lose the Medicaid coverage they had of late gained through the Affordable Care Act But Gordon and his boss Democratic Gov Gretchen Whitmer had reluctantly inherited a law passed two years earlier when Republicans led the state And that law mandated that Michigan institute a work requirement for Medicaid on Jan Gordon and his squad determined that the greater part enrollees were already meeting the law s requirements either because they were already working or had an exemption Thousands more informed their status through the newly built phone and online systems But even so estimates suggested to Michiganders were going to be booted off the rolls within the year That s the population of the city of Flint who were on track to lose their insurance noted Gordon who led the state wellness department until We re implementing this about as well as this thing can be implemented and it is still going to be pretty catastrophic The new tax-and-spending law signed by President Donald Trump in July mandates a vast expansion of Medicaid work requirements to majority of states These systems will lead to million more people being uninsured in according to an estimate from the Congressional Budget Office The law applies to states and Washington D C because they expanded Medicaid in latest years to cover more working-age adults About million people will be affected once the work mandate is fully implemented nationally according to the CBO Unless their state gets an exemption till by these enrollees will need to prove they re working volunteering getting job training or doing other qualifying programs at least hours a month to keep their coverage Republicans say this is a commonsense way to weed out freeloaders Democrats argue that s just political cover for slashing a effort that saved specific lives starting in when the Affordable Care Act was signed through The number of people who lose coverage either temporarily or permanently could vary widely by state depending on how each state implements and maintains its reporting system Michigan s experience illustrates how challenging it can be to stop large numbers of people from inadvertently losing coverage even when leaders try their best to prevent that We were very committed to implementing a law that we didn t agree with in a way that reduced the number of people who lost insurance just because the leadership screwed something up Gordon stated A Year of High-Stakes Work In then-Gov Rick Snyder a Republican waged a fierce battle within his own party to expand Michigan s Medicaid activity To Snyder it was an opportunity to simultaneously save money and expand access By slashing the rate of uninsured Michiganders by almost half the state could reduce the burden of uncompensated care on the fitness system and boost the business sector by improving the physical fitness of the workforce But opponents saw it as an expansion of Obamacare that would shift massive new costs onto state and federal taxpayers A work requirement became a point of compromise and a way for Snyder to mollify chosen of that opposition Related Articles Women and older adults are driving sales of creatine higher Walz issues executive order on vaccines to counter federal limits -year-old Minnesota woman earns grandmaster title in taekwondo As world gets hotter Americans are turning to more sugar research finds Another New Hampshire man gets a pig kidney as transplant trials are poised to start From a coverage perspective Michigan s expansion of Medicaid was a success Low-income adults signed up ballooning new enrollment beyond what even supporters had initially estimated By there were nearly new Medicaid recipients in Michigan and the state was responsible for an increasing share of their vitality care costs Medicaid is paid for jointly by states and the federal administration Fiscal hawks were worried It s now become the largest budget predicament in Michigan explained Jarrett Skorup of the Mackinac Center for Constituents Plan a free-market think tank Snyder signed the bill creating the -hour-a-month work requirement in but it wouldn t go into effect until after he left office That left newly elected Democratic governor Whitmer s administration holding the bag She tapped Gordon who d held senior roles in the federal Office of Management and Budget and Department of Schooling during the Obama administration to lead the sprawling state physical condition department Gordon was terrified that Michigan would become another Arkansas which was the first state to implement a work requirement in The change led more than Arkansas residents to lose their coverage People in Arkansas were disenrolled because computers went down because forms weren t clear because they just never heard about it Gordon announced Maybe they got sicker maybe they died because of this decision If Michiganders lost coverage at the same rate as Arkansans as plenty of as people would have lost their robustness insurance within a year according to one estimate Trying To Make Medicaid Work Requirements Work In particular tactics Michigan was better positioned than other states to implement a work requirement Gordon mentioned The unemployment rate was the lowest it had been in two decades and the state was already pretty good at collecting and tracking employment and wage facts If the state can figure out on its own without having to ask you if you re working that s great because then you don t have to do anything Gordon stated You re just exempted Michigan eventually changed its law to allow people more time to analysis their work sessions and to automatically determine their compliance or exemption by cross-checking information from other assistance programs like food benefits To see if recipients were students or had health-related exemptions Gordon and his crew also tried to capture information from district college enrollment and clinical insurance contends Dozens of staffers reprogrammed the state s outdated benefits enrollment portal created full-time call centers set up audit and appeals processes hired compliance review teams and trained hundreds of local organizers to provide tech and enrollment assistance Forms and letters alerting hundreds of thousands of enrollees to the new strategy were redesigned to be attention-grabbing and easier to understand The sheer amount of effort and time required meant other population medical efforts had to take a back seat Gordon commented Your first job is going to suffer and that is a consequence of work requirements In Michigan Black infant mortality rates were several of the highest in the nation Thousands of people were still dying from overdoses Yet at the state robustness department all of the oxygen in the room was dedicated almost all I should say to the work requirement implementation stated Renuka Tipirneni an internal medicine physician at the University of Michigan who studies Michigan s Medicaid expansion Even after all that work Gordon and his unit had no illusions the system they d spent million creating was flawless There was a real sense that everyone was doing everything they could he mentioned But they still worried that huge numbers of people were going to fall through the cracks Because that s just what happens with systems like this A Waste of Million By the time the work requirement went into effect on Jan the state had been able to determine that the vast majority of the nearly Medicaid expansion recipients already met the work requirement or were exempt That left about people whose status was unknown and who therefore still had to go through the reporting process By March around of those had failed to record and were on track to lose coverage On the one hand it was a lower rate of coverage loss than Arkansas had But it was still an enormous number of people set to lose coverage Gordon explained Before that could happen a federal judge issued a ruling on March blocking Michigan s policies from going forward That same day Gordon was scheduled to testify before a Republican-led subcommittee about how the rollout was going Instead he identified himself explaining to legislators that the state s work requirement was essentially dead in the water and that we had on the demand of the people holding the hearing spent tens of millions of dollars for no purpose Given how brief Michigan s experiment with a Medicaid work requirement was only about two months of the plan s being in effect with no one losing coverage in the end the Mackinac Center s Skorup doesn t see a lot of takeaways about the real-life impacts of work requirements If you have an administration that is not sold on these being necessary at all then I think they re more likely to drag their feet on implementing this which is what I think they did Skorup revealed referring to the Whitmer administration Skorup is concerned because Medicaid costs keep rising with million Michiganders in residents now covered by the initiative or the related Children s Soundness Insurance Plan Skorup believes Medicaid spending is crowding out facilitator pay pensions and roads in the state budget Supporters of Medicaid expansion say the undertaking s expansion has benefited Michigan pointing to research that Medicaid expansion helped boost employment and school enrollment and was a net positive for the state financially Court Ruling Comes Days Before COVID Hits Only days after the court ruling stopped the work requirement in Michigan agents disclosed the state s first cases of COVID- The Michiganders who might have lost Medicaid were spared so their vitality coverage continued as the pandemic unfolded Gordon continued as robustness director until when he resigned over differences of opinion with Whitmer about specific pandemic restrictions These days Gordon is experiencing a sense of d j vu with new predictions showing as a great number of as Michiganders could lose coverage within the first year of federally mandated work requirements according to state estimates We would have a more honest and more efficient protocol if Republicans just kick people off Medicaid he disclosed That would be incredibly harmful he commented But this thing they re doing isn t any less harmful It s just more wasteful administratively and more confusing to everyone This article is from a partnership that includes Michigan Citizens NPR and KFF Vitality News KFF Vitality News Distributed by Tribune Content Agency LLC