Idahoans predict at hearing what will happen if state adds work rules to Medicaid expansion

Carol Augustus walked up to the front of Lincoln Auditorium in her scrubs. She was there to testify before a room of legislators, policy advocates, doctors and other Idahoans.

A part-time home health worker, Augustus makes too much money to qualify for Idaho Medicaid health insurance, but too little to get private health insurance. That means she’s in the “Medicaid gap” — a group of tens of thousands of people whom Idahoans voted to allow onto Medicaid in January.

She and dozens of other people gathered Tuesday at a hearing in the Idaho Capitol to speak out against, or for, a controversial add-on to Medicaid expansion.

Augustus and other low-income Idahoans will be able to enroll in Medicaid in January. That was already decided by voters. What’s at question now, though, is whether federal regulators will allow Idaho to add a “work requirement” to Medicaid for people like Augustus. Under that requirement, most low-income Idahoans would have to file paperwork to prove they are employed, studying or otherwise occupied to get Medicaid.

Similar requirements in other states have been struck down by the courts.

“I do work, I’m just not able to work full time,” Augustus, who lives in Nampa, said at Tuesday’s hearing. “And I’m concerned about people who may have seasonal jobs, (that) they’ll be kicked off the Medicaid expansion. ... People may even die because of it. And there’s other people, too, who are not mentally capable of filling out the paperwork, and I don’t feel they should be kicked off the Medicaid expansion.”

More than 20 others testified at the hearing. Almost all were opposed to the work requirements. A few voiced support for the idea of work requirements, but one said the provision that Idaho lawmakers passed is “so watered down now ... that it’s virtually nonexistent.”

Several state lawmakers showed up to give their support or opposition to work requirements. Nampa Republican Rep. John Vander Woude, who pushed for the requirement during the legislative session, said he believes lawmakers “made enough exemptions in the work requirements, and it’s not to try to hurt people.” Boise Democrats Melissa Wintrow, Sue Chew, Ilana Rubel and Grant Burgoyne universally voiced opposition to the waivers.

Groups that advocated for Medicaid expansion also showed up with a warning: Thousands of Idahoans could lose health insurance under the proposal, they said, based on disenrollments in Arkansas after that state implemented its own work requirements. They also argued that the paperwork requirements would be onerous and expensive to administer, with higher costs for taxpayers.

“The purpose of Medicaid expansion is to provide health care access to low-income Idahoans. ... The vast majority of Idahoans in the gap are working. This isn’t about not working,” said Sam Sandmire, whose group Reclaim Idaho gathered signatures to get Medicaid expansion on the ballot. “There’s a great risk that Idaho’s paperwork restriction will create a second gap of thousands of people (who will) be forced to seek ... expensive emergency room care.

The Idaho Department of Health and Welfare is accepting public comment on the work requirements through Sept. 22 via email to — or by mail to Cindy Brock, Medicaid Program Policy Analyst, Division of Medicaid, P.O. Box 83720, Boise — and plans to submit the waiver application to the Centers for Medicare and Medicaid Services after that. The centers may then decide to approve or reject the waiver.

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