Let’s look at Medicaid from a practical perspective

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Medicaid provides health insurance and access to health and mental health care to over 1.3 million Minnesotans. It supports our local institutions — hospitals, pharmacies, clinics, nursing homes. Without these payments, we would likely see uncompensated care rise, and more financial instability for providers and patients.

Congress and the current administration will have to significantly cut Medicaid funding if it is to meet their budget target of cutting $880 billion from the federal budget. This has been verified by the nonpartisan Congressional Budget Office.

One of the ideas to cut funding for Medicaid is by instituting work requirements. On the surface people might agree with this proposal because they believe that people receiving public benefits should work. But let’s take a closer look.

First, we would of course exclude children, people with disabilities and older adults. When we look at who is left, most studies find that two-thirds of people on Medicaid are already working, and either are not offered health insurance through their employer or cannot afford it due to their low wages. The Kaiser Family Foundation reported that 92% of Medicaid recipients were working full- or part-time (64%), or not working due to caregiving responsibilities, illness or disability, or school attendance. The remaining 8% of Medicaid adults reported that they are retired, unable to find work or were not working for another reason.

Then who are the people who are not working?

Parents can struggle to find any child care — to say nothing of affordable child care — making it very difficult to work. Someone has to take care of young children who cannot be left alone.

Most serious mental illnesses emerge by the age of 26. We see many young people applying for Medicaid who have serious mental illnesses because they are low-income and the very services and treatments they need to get better are not covered under private insurance.

At this point in their life, they are likely not to be certified as having a disability by the Social Security Administration. It can take eight months or longer from the time one applies to when a decision is made, and more than 70% of first-time disability applications are denied. It is very difficult to be certified as having a disability when you have a mental illness, and many have to appeal denials several times before finally being approved — a process that can easily take five years. So, these young people would not be among the group that would be excluded.

Due to the symptoms of their mental illness, many have difficulty holding down a job, but also finding a job that provides health insurance benefits. Leaving the hospital after a first psychotic episode typically means you need intensive treatment for several months, making it impossible to work. Yet these are the very people who would be impacted by the work requirement.

The experience of work requirements in Arkansas shows that 18,000 adults lost coverage and faced medical debt, delayed care or stopped taking their medications. Verifying that you were working or should be exempt was very difficult because counties did not have the infrastructure to track work hours and people who were working lost coverage due to red tape. Some people were not computer literate or didn’t have access to the internet to record their information into the online portal. And, ironically, the work requirement didn’t lead to higher levels of employment.

NAMI Minnesota, a nonprofit organization dedicated to improving the lives of children and adults with mental illnesses and their families, simply does not support work requirements — or any other ways that would cut access to Medicaid or decrease payments to our already underpaid mental health providers. People with mental illnesses — due to lack of enforcement of mental health parity — depend on Medicaid to access the very services they need to be able to work. We don’t really want young adults to tell the Social Security Administration that their disability prevents them from working simply to access Medicaid. We want to provide the services and supports that help them become employed. Let’s not cut funding for Medicaid simply to provide tax cuts to people with high incomes. A healthy state requires healthy people, and now is not the time to cut Medicaid.