Medicaid work requirements hotly debated at Legislature

The debate at the Minnesota Capitol over a proposed work requirement for some on Medicaid has drawn renewed focus on 2014 — the year that more than 47,000 Minnesotans lost food stamp benefits after work requirements were reintroduced for that program.

That number has now grown to 66,000 "able-bodied" Minnesota adults without dependents who have lost food stamp eligibility since the federal government reinstated work requirements that had been suspended due to high unemployment after the Great Recession.

Today, only 6,000 such adults are still on the food stamp program in Minnesota, known officially as the Supplemental Nutrition Assistance Program (SNAP). That doesn't include people in Minnesota counties or tribal areas where unemployment remains high and work is not required.

President Donald Trump on Tuesday signed an executive order that requires federal agencies to make recommendations to strengthen existing work requirements or institute new ones for safety net programs, including food stamps, welfare and public housing. The Trump administration is the first to allow states to adopt work requirements for Medicaid.

Critics of work requirements say that their impact on single adults in SNAP should serve as a cautionary tale about what could happen if Medicaid were to adopt similar standards.

"The SNAP system is absolutely illustrative of what will happen in health care," said Jessica Webster, a staff attorney with Mid-Minnesota Legal Aid. "These requirements find savings by removing people, and they are removing eligible people."

The work requirement, she said, is "an administrative nightmare" and hard for counties to implement.

But Rep. Matt Dean, R-Dellwood, said work requirements make good policy. Pointing to computer problems with the MNsure system and the state's Medicaid eligibility system — which Legislative Auditor James Nobles found to be inaccurate — Dean said there needs to be more study on what happened with SNAP.

"The people who can work should work. I agree with that precept," Dean said. "But right now the systems don't work, and we've got to understand why. If we get the systems that work, we are going to save a lot of money."

Sen. Michelle Benson, R-Ham Lake, a supporter of Medicaid work requirements, said she hoped "the people that were asked to implement work requirements would continuously be working to improve the process so we do this correctly."

SNAP serves 438,000 Minnesotans in all, many of whom don't have to work because they are elderly, pregnant, have a disability or qualify as a family unit.

As the economy has improved, overall enrollment has decreased 12 percent since early 2015. Reasons for the exodus from the program aren't clear.

The Minnesota Department of Human Services, which administers the federally funded program, does not track how many food stamp recipients lost benefits because they weren't working, how many failed to comply with reporting requirements, or how many were unable to work but couldn't get an exemption.

State officials concede they weren't prepared for the federal reinstatement, which might have contributed to the large numbers leaving SNAP.

"I wouldn't just throw the counties under that bus," said Jim Koppel, assistant commissioner at the Human Services Department. "The state wasn't prepared, and that is why there was such a complete devastation of that enrollment."

Four years after the SNAP work requirements returned, state and counties are still refining policies that determine whether some people can keep government food support or lose it altogether.

"We were soundly criticized by many advocates and that is what led to us forming a work group, and we really tried to respond to it in a healthier way," Koppel said.

The state recently approved a task force recommendation to exempt some homeless people who also have additional barriers to obtaining employment.

Single adults can receive three months of SNAP benefits, which average $105 a month. If they don't work 80 hours a month by the fourth month, they can lose benefits entirely.

In early 2014, the three-month window for many people began to close and benefits were cut. Food shelves and legal aid offices began to receive a large number of complaints. In a short period of time, county case workers were flooded with paperwork and high caseloads. New employees were unfamiliar with policies and procedures.

Many beneficiaries did not know of the new policy because notices mailed to them from counties had been sent to old addresses. Others did not know how to react.

"There are some very sick people who have lost benefits and very vulnerable single adults," Webster said. "Some of these people have low functional literacy skills, or chronic health and chronic mental health challenges."

The population targeted for work requirements in SNAP and under proposed Medicaid work requirements tend to be the most difficult to reach. State and county officials say they should have done more at the time to involve nonprofit organizations that provide services to the community.

"There wasn't a lot of outreach to community organizations to help people understand what was happening," said Deborah Huskins, director of the Human Services Department at Hennepin County. "We didn't think it through on the impact on people proactively because it happened pretty quickly."

Officials with Catholic Charities of St. Paul and Minneapolis said the change had a big impact on their clients.

"There was a frustrating impact to the people that we serve," said Carina Aleckson, community program development manager.

Catholic Charities also helps people on SNAP find employment, but job training often takes longer than the three-month grace period SNAP allows before the work requirement kicks in.

"People experiencing homelessness often lose their SNAP benefits before they complete the training program," Aleckson said. But a recent policy change means homeless people can remain on SNAP while they continue to train.

But even as state and county officials adjust policies, the number of single individuals on SNAP in counties with work requirements continues to drop.

"It is really hard to get someone to come back and apply for a program if they have been denied," said Colleen Moriarty, executive director of Hunger Solutions Minnesota, which works with state food shelves.

Use of food shelves across the state exploded during the recession and have remained at about 3 million visits a year, despite lower unemployment. Moriarty said demand remains high due to low wages and partly because many people lost SNAP benefits.

"The biggest funder of anti-hunger is the federal government," Moriarty said. "The emergency food system is just not able to absorb those increases. There are just not the resources."

Glenn Howatt • 612-673-7192