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The Centers for Medicare and Medicaid Services’ decision to grant Ohio’s work requirement request could boost Medicaid recipients’ earnings, proponents say, while critics say the decision could cost 36,000 Ohioans their access to healthcare.

The federal agency last week granted a waiver for Ohio, allowing the state to require able-bodied Medicaid expansion recipients to work at least 20 hours per week in exchange for coverage. Recipients can receive an exemption from the work requirement for several reasons, including if enrolled in a worker training or drug treatment program.

Ohio’s Medicaid expansion includes about 711,000 adults, according to the Kaiser Family Foundation. An August 2018 report from the Ohio Department of Medicaid found 95 percent of the Medicaid expansion population in Ohio either meets the work requirement or is eligible for an exemption, meaning roughly 36,000 Ohioans could lose their coverage.

“I believe the taxpayers will support it as long as it’s a hand-up and not a hand-out policy,” Lt. Gov. Jon Husted said in a statement. “… Ohioans want to help people but they also want people to help themselves.”

Ohio officials say there are more than 100,000 jobs on OhioMeansJobs waiting to be filled.

One unanswered question is how recipients will report the hours they are working. A cumbersome, bureaucratic process could force people off the rolls if they cannot complete the reporting requirement, said Daniel Skinner, a health policy professor at Ohio University’s Heritage College of Osteopathic Medicine.

Skinner said the “coercive approach” is “short-term thinking” and could result in more costs in the long term.

“One of the challenges we have in politics is to get people to think long term,” Skinner said. “The long-term consequences for 40,000 to 50,000 Ohioans losing their access to Medicaid could be really dramatic."

The state officials responsible for administering the Medicaid program lauded the news of the federal waiver.

“By promoting economic self-sufficiency, Ohio can improve the well-being of the state’s workforce and families while providing health care for our most vulnerable citizens,” said Maureen Corcoran, director of the Ohio Department of Medicaid, in a statement. “Our objective is to connect able-bodied individuals on Ohio Medicaid with the resources they need to succeed. By working together with our state and local partners, we can keep Ohioans healthy and help them find meaningful employment.”

In a recent report, public policy think tank The Buckeye Institute found imposing work requirements on healthy, single individuals with no children could increase their lifetime earnings, even if the individual remains on Medicaid for their entire working life.

It “is now the responsibility of the state to develop a system that allows Medicaid enrollees to easily report their time working, and that ensures no one deserving of services is kicked-off the [rolls] due to an overly cumbersome reporting process,” Rea S. Hederman Jr., executive director of the Economic Research Center and vice president of policy at The Buckeye Institute, said in a statement.

The Center for Community Solutions raised concerns, including about the potential additional costs it will impose on county governments and whether the Ohio Benefits system can collect the needed data to administer this program.

“Legislators who are being responsible don’t just make policy for a time when things are good,” Skinner said. “… What’s going to happen in four years when the next recession comes or eight years when the next recession comes? My guess is that we’re going to be rethinking these continually.”