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The clock is ticking for hundreds of thousands of Pennsylvanians who will likely be affected by new Medicaid work requirements, which take effect in January
And health advocates say the impact could be greater than they initially expected when President Donald Trump signed the Medicaid rules and funding cuts into law a year ago
At the time, Pennsylvania state leaders estimated that more than 300,000 residents could lose insurance coverage under the law
Now, Pennsylvania patients and health advocates say those losses could include more people who are managing mental health issues, substance use disorders and serious illnesses if theyfail to get an exemption to the new federal participation requirements
Recent guidance on those exemptions present new hurdles for vulnerable populations, advocates said
“We were expecting this to hurt. We were expecting people to lose care and to have less care and lives to be shortened as a result,” said Michael Berman, state director of Protect Our Care PA, a grassroots health care advocacy group. “And one year in, it is looking like it is worse than we thought it would be.”
New Medicaid eligibility rules and restrictions
The massive tax and spending bill that Congress passed last summer mandates that people who get Medicaid health insurance must work at least 80 hours a month, with some exceptions
Volunteering or being in school at least part-time can also count toward the requirement. People will eventually need to provide proof of their activities and complete annual eligibility paperwork in order to keep coverage
The rules apply to states’ Medicaid expansion populations. In Pennsylvania, about 750,000 people are covered under that expansion, state data shows
Residents like 62-year-old Felix White, who lives in Montgomery County, said he worries about what the new rules and restrictions will mean for keeping his Medicaid insurance coverage, which is essential in managing his Type 1 diabetes
“I see several doctors a year just to manage my diabetes alone, including a cardiologist, endocrinologist, an ophthalmologist,” White said. “Over the years, I’ve gone through a number of health problems and take a lot of life-sustaining medications that keep me alive.”
The looming work requirements are intimidating, White said
After a long career in computer science, he lost his job a couple of years ago and struggled to find another position in the field at his age. He’s been doing odd jobs like lawn mowing ever since. But cobbling together a consistent 80 hours of work a month isn’t a guarantee
He also spends a significant amount of time caring for his 92-year-old mother
“Medicaid saves lives, and losing it would be a death sentence for me,” White said
The federal law did make room for exceptions to the work requirements, particularly for pregnant and postpartum women, people who are “disabled or medically frail,” caregivers of young children and family members with disabilities, and those in treatment for alcohol or drug addiction
But the Centers for Medicare and Medicaid adopted a more specific definition of “medically frail” in aninterim final rule published last month. In addition to having a qualifying condition, people will need to prove that their medical needs “significantly impair their ability to comply with the requirement.”
Fears about Medicaid work requirements and exemptions
This could become overly burdensome for people trying to manage complex mental health conditions, said Dr. Jeannine L. Lisitski, president and CEO of Mental Health Partnerships, a mental health and social services nonprofit based in Philadelphia
“For people managing serious mental illness or substance use disorders, more paperwork becomes yet another barrier to staying healthy enough to be able to work,” she said
Delays or mistakes in filing paperwork could also create problems for people who are clearly eligible for exemptions. A woman battling breast cancer, for example, could still lose coverage, even temporarily for days or months, said Joanna Rosenhein, director of community engagement at the Pennsylvania Health Access Network
“During those months, she wouldn’t be able to pick up her medications or receive chemotherapy treatment,” Rosenhein said. “Cancer patients and patients with other serious illnesses can’t afford to have coverage interrupted for any reason.”
Some lawmakers are trying to appeal the new Medicaid rules and funding cuts. U.S. Rep. Brendan Boyle, a Democrat who represents Philadelphia, introducednew legislation this month that would “fully reverse the largest cut to Medicaid in American history.”
“Unless Congress takes any sort of action, unless something is done to fix this, millions and millions more will lose their health care coverage, and hundreds of millions more still will face higher costs or simply the denial of services altogether,” he said Wednesday
Meanwhile, Pennsylvania patients and health advocacy groups said they are working to raise awareness on how the new rules could affect communities
“We’re saddened that the administration has chosen to make this harder than it was laid out in the original law with some of these new rules,” Berman said. “So, we will keep an eye on it, we will monitor it and we will do what we can to make it better, but these are not good days, I think, for health care in America.”
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