South Florida Hospital News
Monday April 6, 2020

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February 2020 - Volume 16 - Issue 8




Medicaid Policy … Healthcare Industry Opinions, and a Meaningful Policy Focus

One of the most controversial Medicaid policy efforts is mandating able-bodied Medicaid beneficiaries to work, search for work, or perform voluntary services.

Proponents of the Medicaid work requirement believe the policy will decrease cost by slowing or reducing enrollment, and it is good policy to incentivize people to work or contribute to the greater good of society. Policy critics opine a work requirement adversely impacts people that should be exempt due to such factors as illness or disability. There is also concern the target population cannot navigate very complex enrollment and compliance requirements.
• The Center for Budget and Policy Priorities estimates between 77% (1.4 million people) and 83% (4.0 million people) would lose Medicaid coverage if a work requirement was imposed nationwide.(1)
South Florida Hospital News and Healthcare Report research shows healthcare industry executives and professionals are split on this issue. More than half (57%) of respondents to a national study that believe the Republican party has the best overall healthcare policy platform support the work requirement policy versus 18% of their Democratic counterparts. Efforts to implement the work requirement policy is mostly in states voting Republican in the 2016 presidential election. As of December 20, 2019, 17 of the 19 states(2) seeking a Medicaid work requirement waiver (Section 1115) voted Republican.
The courts are making the Medicaid work requirement a mute initiative. While work requirement initiatives are not totally legally dead, they are on life support.(3) States don’t want the added cost burden of new information technology systems, administrative staff, and other associated administrative expenses.(4) Further, there is evidence the policy may not increase the number of Medicaid recipients that work or enter into public service. Arkansas’ 2018 implementation of the Medicaid work policy resulted in 18,000 people losing coverage and fewer people providing “community engagement activities.”(5)
There is a better policy initiative that will have a meaningful impact on reducing cost and promoting better care according to Bill Sampsel of Health Metrics. “Our analysis of State of Florida and national data, and many scientific studies supports initiatives for getting Medicaid patients out of emergency departments and into lower-cost settings like urgent care centers and community health centers run by safety-net hospital systems.” Specifically:
• Nationally, Medicaid recipients account for 23% of hospital discharges and 32% of emergency department (ED) visits. Most (92%) Medicaid ED utilizers are not admitted to the hospital.(6)
• Florida Medicaid recipients comprise 19% of hospital discharges and 31% of emergency department visits.(7)
• Scientific studies show access barriers to primary care accounts for upwards of 87% of all ED visits.
State and national policymakers are aware of the benefits of promoting policies that will keep Medicaid patients out of the emergency departments. Progress towards implanting meaningful regulations is slow.
Gerald Cohen a South Florida healthcare attorney concurs. “The industry does not have to wait for policy implementation to: Expand access to community/primary care networks (number of locations and hours of operation), incentivize Medicaid recipients to use lower cost options for primary care services, and implement support systems that allow Medicaid recipients to access the appropriate site of care.”

Richard Klass, Vice President and Co-founder, KCI Partners, Inc., can be reached at

3 M. Brady (11/11/19), Modern Healthcare, GOP states to swerve as Medicaid work requirements hit legal wall, According to Joan Alker, Executive Director of the Center for Children and Families, Georgetown University McCourt School of Public Policy, p 8.
4 Ibid, according to the U.S. Government Accountability Office report.
5 Ibid, according to the New England Journal of Medicine.
6 Agency for Healthcare Research and Quality, HCUPnet, Healthcare Cost and Utilization Project, 2016 data.
7 Florida Agency for Healthcare Administration, 2017/2018 data.
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