Alabama appears likely to join a growing list of states considering a work requirement for some adult Medicaid recipients, according to state Medicaid officials and Gov. Kay Ivey.
The Trump administration last week released guidance letting states test ‘a work requirement’ for adult Medicaid enrollees — a first in the program’s history. Following the guidance, 10 mostly Republican states submitted waiver proposals that would let them deny coverage to ‘able-bodied’ recipients who are unemployed. Alabama was not among them at the time.
Medicaid covers about one in four Alabamians. This year the Legislature appropriated more than $800 million for the program, including a $105 million supplement from the state’s BP oil spill settlement. Ivey said she instructed Medicaid Commissioner Stephanie Azar in October 2017 to begin working on work requirements and higher copays.
‘Improving Medicaid delivery and controlling costs is central to my budget,’ Ivey said. Agency communications director Robin Rawls said a requirement could be ‘an incentive to encourage people to move into the workforce,’ though no official proposal exists yet and public comment would be required.
More than half of Alabama’s roughly 1,050,117 Medicaid-eligible patients are children, and of the 126,000 eligible in Mobile County in 2016, 58 percent were under 19. The federal guidance makes clear any work requirement would not apply to children, the elderly or pregnant women. A recent report found Alabama already runs the leanest Medicaid program of any state by the average medical benefit received per enrollee.