The nation\u2019s first mandated work requirement for Medicaid recipients, approved by the Republican-led Congress and signed by President Trump, is expected to have a seismic effect in California.<\/p>\n
One estimate from state health officials suggests that as many as 3.4 million people<\/a> could lose their insurance through what Gov. Gavin Newsom calls the \u201clabyrinth of manual verification,\u201d which involves Medi-Cal recipients proving every six months that they are working, going to school or volunteering at least 80 hours per month. <\/p>\n \u201cIt\u2019s going to be much harder to stay insured,\u201d said Martha Santana-Chin, the head of L.A. Care Health Plan, a publicly operated health plan that serves about 2.3 million Medi-Cal patients in Los Angeles County.<\/p>\n She said that as many as 1 million people, or about 20% to 40% of its members, could lose their coverage.<\/p>\n The work requirement will be the first imposed nationwide in the six-decade history of Medicaid, the program that provides free and subsidized health insurance to disabled and low-income Americans<\/a>. <\/p>\n It\u2019s relatively uncharted territory, and it\u2019s not yet clear how the rules will shake out for the 5.1 million people in California who will be required to prove that they are working in order to qualify for Medi-Cal, the state\u2019s version of Medicaid. <\/p>\n After the 2026 midterm elections, millions of healthy adults will be required to prove every six months that they meet the work requirement in order to qualify for Medicaid. The rule applies to those whose income is between 100% and 138% of the federal poverty limit, a group that became eligible for Medicaid when the program was expanded under the Affordable Care Act. <\/p>\n The new mandate spells out other exceptions, including for people who are pregnant, in addiction treatment or caring for children under 14. <\/p>\n Democrats have long argued that work requirements generally lead to eligible people losing their health insurance due to bureaucratic hurdles. Republicans say that a work requirement will encourage healthy people to get jobs and preserve Medicaid for those who truly need it.<\/p>\n \u201cIf you clean that up and shore it up, you save a lot of money,\u201d said<\/a> House Speaker Mike Johnson of Louisiana. \u201cAnd you return the dignity of work to young men who need to be out working instead of playing video games all day.\u201d<\/p>\n Only three U.S. states have tried to implement work requirements for Medicaid recipients: New Hampshire, Arkansas and Georgia. One study found that in the first three months of the Arkansas program, more than 18,000 people<\/a> lost health coverage. <\/p>\n People can lose coverage a variety of ways, said Joan Alker, a Georgetown University professor who studies Medicaid. Some people hear that the rules have changed and assume they are no longer eligible. Others struggle to prove their eligibility because their income fluctuates, they are paid in cash or their jobs don\u2019t keep good payroll records. Some have problems with the technology or forms, she said, and others don\u2019t appeal their rejections. <\/p>\n Of the 15 million people on Medi-Cal in California, about one-third will be required to prove they are working, the state said. Those people earn very little: less than $21,000 for a single person and less than $43,000 for a household of four.<\/p>\n The state\u2019s estimate of 3.4 million people losing coverage is a projection based on what happened in Arkansas and New Hampshire. <\/p>\n But those programs were brief, overturned by the courts and weren\u2019t \u201ca coordinated effort among the states to figure out what the best practices are,\u201d said Ryan Long, the director of congressional relations at the Paragon Health Institute, a conservative think tank that has become influential among congressional Republicans.<\/p>\n Long said advancements in technology and a national emphasis on work requirements should make work verification less of a barrier. The budget bill includes $200 million in grants<\/a> for states to update their systems to prepare, he said. <\/p>\n Arguments from liberal groups that people will lose healthcare are a \u201cstraw man argument,\u201d Long said: \u201cThey know that the public supports work requirements for these benefits, so they can\u2019t come out and say, \u2018We don\u2019t support them.\u2019\u201d <\/p>\n A poll by the health research group KFF<\/a> found this year that 62% of American adults support tying Medicaid eligibility to work requirements. <\/p>\n The poll also found that support for the policy drops to less than 1 in 3 people when respondents hear \u201cthat most people on Medicaid are already working and many would risk losing coverage because of the burden of proving eligibility through paperwork.\u201d <\/p>\n