Four days ago, AQPQ.org published a blog post that praised the Commonwealth of Kentucky’s new Medicaid program for supporting the principles of flexibility and choice. And yet, with some trepidation, the post also suggested that the imposition of an “administrative deductible account” may make the program too complex to succeed.
Do you disagree? Do you believe, instead, that Kentucky’s deductible account is a manageable feature? Even if you do, you may wish to pause before expressing general support for the program. Regrettably, there is a different feature that is even more complex than the deductible account!
What is that feature? It is the work requirement that is imposed on Medicaid recipients. Although the Obama Administration refused to require employment as a precondition for receiving medical services, the Trump Administration has endorsed Kentucky’s decision to require it.
Reasonable minds may differ about the moral implications of requiring people with maladies to work for their medical care. But all reasonable individuals should be willing to agree that any work requirement — or any other requirement, for that matter — must be defined in a manner that isn’t hopelessly complex.
So … is Kentucky’s Medicaid work requirement too complex to succeed? Let’s review the guidelines of the HEALTH Program’s Requirements Specification and decide for ourselves.
First and foremost, because there is no way for the Commonwealth to guarantee the availability of work, the Program merely requires “Community Engagement” instead of work. At first glance, that sounds like a reasonable policy, doesn’t it?
But there’s a catch. To assess whether a Medicaid patient satisfies the Community Engagement requirement, program managers must complete a calculation. Thirty hours of employment per week may meet the requirement, but there are many reasons for claiming a “temporary good cause exception” from work. Inclement weather, for instance, is defined as a valid reason, although the guidelines do not explain how any particular storm would trigger an exception.
Nevertheless, all hours and exceptions must be registered through an online time accountability system. Various Forms are produced by the system, with Form 834 utilized to report deviations from the Community Engagement requirement.
How complex is the language that explains these guidelines? Clause 18.104.22.168 represents a typical set of instructions:
MCO CE Communication.
Members CE status and required CE hours must be provided by MMIS to the MCO’s on the 834, on at least a monthly basis for the current month. The MCO’s may send communication and outreach to members based on CE status received from MMIS.
Information received by the CE module regarding member good cause exceptions involving incidents that may invoke third party liability (TPL) must be provided by MMIS to MCOs for purposes of pursuing TPL payments.
There are also time accrual guidelines, time exclusion guidelines, and non-compliance “curing” guidelines. In addition, there are program suspension guidelines, reactivation guidelines, and grace period guidelines. Not to mention the existence of a completely separate section of guidelines regarding time spent on Education and Training activities!
To reiterate the questions that we asked in our previous AQPQ.org post regarding Kentucky’s deductible accounts feature: How many government employees will be required to manage this work requirement system? How many will even be able to explain the system to baffled Medicaid recipients?
Employment is undoubtedly a worthy goal. But if Kentucky’s work requirement is simply too complex to succeed, its Medicaid program will inevitably fail.