Oklahoma officials say challenges ahead for Medicaid work requirement
Matilda Williams doesn't rely on Soonercare for her insurance, but she still decided to make the hourlong drive from Seminole on Tuesday to state her opposition to proposed work requirements.
Williams, 70, was one of a handful of members of the public who attended a forum held by the Oklahoma Health Care Authority on Tuesday afternoon at Variety Care's Lafayette clinic. The authority held the meeting to answer questions and take public comment about a proposal to require some adult Soonercare beneficiaries to work at least 80 hours per month.
Williams said she came because she opposes efforts to “shred” safety net programs.
“I'm safe, I have my social safety net, but my grandchildren and nieces and nephews don't,” she said.
In March, Gov. Mary Fallin ordered the Health Care Authority to pursue a work requirement. She said at the time that a work requirement would help low-income people covered by Soonercare, Oklahoma's Medicaid program, to “attain capability for independence.”
Applying for a Medicaid requirement isn't as easy as signing up for a mailing list, though. The Health Care Authority will submit its proposal to the federal Centers for Medicare and Medicaid Services in October. Tywanda Cox, chief of federal and state policy at the Health Care Authority, said she expects about two months of negotiations between the authority and federal health officials before the federal agency even considers the request.
Even then, it's still far from guaranteed. The federal agency has yet to approve a work requirement in states that didn't expand Medicaid, Cox said.
People younger than 19 and older than 50 would be exempt under the proposal, as would pregnant women, parents of children younger than 6 and people who can prove a disability. Cox estimated about 6,000 people would be subject to the requirements statewide. Current members would be grandfathered in until it's time for their annual eligibility renewal, she said.
Marilynn Knott, an Oklahoma City resident, said she worries some recipients will end up losing eligibility because hours can be unpredictable in low-wage jobs. Recipients also could fulfill the requirement by doing volunteer work.
“You're talking about a nightmare to administer,” Knott said.
“You're right. It is going to be taxing for us,” Cox said.
The authority still is working out details of the program, such as how to address problems like inadequate transportation and child care that can keep low-income parents from working, she added.
Oklahoma limits its Medicaid program for adults with severe disabilities to those earning 45 percent of the poverty line or less — $9,348 annually for a family of three. Cox said the authority doesn't want to force any of the recipients off the program, and is trying to figure out options for people who end up making too much to qualify for Medicaid, but not enough to buy insurance.
“These are people at the lowest levels of poverty,” she said. “Our goal is that no one loses coverage.”
Proposed Soonercare work requirement exemptions
• People younger than 19 or older than 50
• Pregnant women
• Parents caring for children younger than 6 or for an “incapacitated” person of any age
• People receiving Social Security disability payments, or those who have a doctor’s certification that they are unable to work
• Patients in substance abuse treatment
• Members of an American Indian tribe
• Parents of foster children
• Former foster children who aged out, but are younger than 26
• Women enrolled in the Oklahoma Cares breast and cervical cancer program
• People enrolled in SoonerPlan for contraception
• Inmates released from jail or prison in the last six months
Source: Oklahoma Health Care Authority