Affordable Care Act, Health Policy, Health Reform, Inequality, Medicaid, Pennsylvania, Social Determinants of Health, Uncategorized

Pennsylvania Lawmakers Move Forward with Medicaid Work Requirements

On April 16th the Pennsylvania House of Representatives voted to pass House Bill 2138 providing work requirements as a condition of receiving Medical Assistance (Pennsylvania’s Medicaid program). This bill is one of several currently making their way through the Pennsylvania legislature that would detrimentally affect low-income families and children, cost the state hundreds of millions of dollars to implement, and generally serve no valid public interest other than to deter individuals who need life saving benefits from getting them.

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House Bill 2138 mandates that Medical Assistance enrollees must work 20 hours per week or complete twelve “job training program-related activities” per month in order to maintain the benefit. Individuals who fail to comply with this requirement will lose their eligibility for three months initially, then six months, and then nine months. Individuals who are 19 years and older must verify compliance with the work requirements on a biannual basis and by request from the State. Furthermore, the State can delay enrollment if the individual is found to have failed to comply with these requirements.

Certain populations are exempt from the work requirements including: full-time high school students; individuals receiving temporary or long-term disability benefits; individuals under 18 years of age and 65 and over; pregnant women; individuals receiving Supplemental Security Income (SSI); primary caregivers for dependents six years of age or younger; and primary caregivers for individuals who are permanently disabled or in hospice care. Additionally, individuals who are experiencing a crisis, serious medical condition, or temporary condition that prevents the enrollee from actively seeking employment, including domestic violence and substance use disorder, are exempt.

The process in which individuals seeking exemption must participate in, including paperwork and verification requirements, is unclear based on the bill alone; however, the current Secretary of Human Services, Teresa Miller, reported that it would cost $650 million and an additional 300 staff members to enact these changes in her department. Now that the bill has passed the House, it moves on to the Pennsylvania Senate for a vote.

Policy experts find that work requirements harm families and individuals who are already working the most. Moreover, work requirements rarely lead to additional employment, but often lead to disenrollment, stripping vulnerable individuals of critical benefits and services. One study found, “four to five years after such requirements were implemented, about 70 percent of the welfare recipients who went off welfare because of work requirements had no income, or had income at or below 50 percent of the poverty line.”

Since the Centers for Medicare and Medicaid Services (CMS) changed its policy on work requirements in January 2018, Kentucky, Arkansas, and Indiana have had Medicaid waivers approved that include work requirements. Pennsylvania is among several other states in the process of establishing a pathway for work requirements.

It is critical that Pennsylvania residents and residents of other states seeking to implement these changes reach out to their elected officials urging them to stop their assault on poor families. The Pennsylvania Health Access Network has an easy form to find your State Senator and submit a letter urging her or him to vote NO on work requirements.

*This article was cross-posted on http://www.helpmlp.org.

Education, Health Disparities, Health Equity, Inequality, Medication, Social Determinants of Health

Using Medication to Treat Social Ills

The critical need for a social determinants approach to health care is illustrated in an article in today’s NY Times.  In “Attention Disorder or Not, Pills to Help in School” Atlanta doctor, Michael Anderson, explains that he prescribes Adderall to help even the educational “playing field” for low-income students.  Prescribing Attention Deficit Hyperactivity Disorder (ADHD) medication helps provide an edge to low-income students who are often struggling in schools that are under-resourced, yet are competing with students from higher-income families and schools for college admissions.  Dr. Anderson sees himself as employing his form of “social justice” noting, “I don’t have a whole lot of choice. We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

The possible short and long-term effects of prescribing stimulant ADHD medication to adolescents are discussed within the article, and some may find it shocking that parents and physicians would choose to prescribe medications in light of these risks.  However, a quick look at national disparities data shows that obtaining higher education is a matter of life or death.  According to the Robert Wood Johnson Foundation, college graduates are expected to live at least five years longer than those who do not graduate from college.  A mother’s education is also correlated with infant mortality; the lower her educational attainment the higher the risk for infant mortality.  Additionally, the higher one’s education the less likely they are to develop chronic diseases such as diabetes, heart disease, and obesity.  While Dr. Anderson’s clinical practices are certainly controversial and guaranteed to invite criticism, I applaud him for exposing such an important issue and calling for policies that address the true causes of health and social inequities.