Two leading congressional Democrats want to know what it will cost conservative states to verify eligibility requirements for their Medicaid recipients, echoing concerns within the states that the changes curb enrollment and add expenses.
The Democratic ranking members of the Senate Finance and House Energy and Commerce committees, Sen. Ron Wyden of Oregon and Frank Pallone of New Jersey sent an oversight letter to the Government Accountability Office Tuesday asking officials to look how state and federal dollars are being spent to administer new Medicaid requirements such as work mandates and premium cost-sharing.
The Trump administration has given three states — Kentucky, Indiana and Arkansas — the green light to require able-bodied adult Medicaid enrollees to work or volunteer in order to get health coverage.
Alabama is getting ready to close the open comment period for its own Section 1115 Medicaid waiver that would also impose a work requirement on a much smaller population that is mostly made up of the elderly and disabled, along with working poor parents with dependent children.
In their letter, Wyden and Pallone cite the estimated $374 million Kentucky would need over two years to implement its newly approved work requirement.
They also note that the premium cost-sharing Indiana and Michigan require for their Medicaid populations have also been expensive, as analysts from the Kaiser Family Foundation have said, although the true cost is unknown.
"The public should have complete information about the consequences of proposed Section 1115 waivers to ensure limited taxpayer dollars are being used efficiently, appropriately, and towards the goal of promoting, not obstructing, access to healthcare," Wyden and Pallone write.
Advocates and providers in Alabama say the cost of administering such a proposal would cost the state a burdensome amount of money while also overloading the already frail health system with uncompensated-care costs.
"There is no point in doing what they're doing," Larry Gardella, who worked in benefits administration for the state as well as for Alabama Legal Services, told Modern Healthcare. "There are so few people they will get, and the administrative part of it will eat them alive. This is going to be an administrative nightmare if they really try to implement it."
It is unclear whether the CMS will approve Alabama's application. The Trump administration approved the requirements for Kentucky, Indiana and Arkansas, all of which have a significantly higher population of adults of working age in Medicaid because they expanded their programs.
Danne Howard of the Alabama Hospital Association said that the group emphasized in its comment letter to the Medicaid agency the higher stakes for non-expansion states. Alabama has seen a high number of rural hospitals close, and is slated to see even more closures this year.
"We are happy to come to the table and consider work requirements in the context of Medicaid expansion," Howard said.
Correction: An earlier version of this story incorrectly stated the recipient of the lawmakers' letter. The error has been corrected.