HOOVER — At a public hearing in one of Alabama's most affluent suburbs Tuesday, not a single local resident rose to speak in favor of Alabama's proposal to institute a work requirement for some adults on Medicaid.
Of the dozen or so who did speak, many said they were mystified by the decision to require about 75,000 Medicaid recipients to get a job or lose their coverage.
“These are not people who are lying out at the spa, living on the dole,” pediatrician Francis Rushton, a Birmingham pediatrician, said at the meeting at the Hoover Public Library.
Medicaid officials are seeking public input on a plan that could whittle down the rolls of Alabamians on Medicaid, who now number about 1 million.
It's virtually impossible for a single, non-disabled adult to qualify for the program. Parents who care for kids on Medicaid can get coverage themselves, if their family income is 13 percent of the federal poverty level or less. That adds up to about $247 per month for a single mom with one child.
The state Medicaid Agency is seeking federal permission to require those parents to spend some of their week in “employment-related activities,” either working at or working to get a job. Adults would have to spend 20 to 35 hours per week on the job or a job search, depending on the age of their kids.
State officials cite record-low unemployment, about 3.5 percent in December, as one reason for the shift. They've also said working is good for both parents and the children they raise.
"Parental employment, and the economic security it brings, is critical to young children," Medicaid officials wrote in their application for permission to begin the program. Officials didn't comment on the plan Tuesday. The Hoover meeting was one of two they held to record public sentiment on the plan, part of their federal application.
Several other states have requested or considered Medicaid work requirements in recent months, though many of those states, such as Arkansas and Kentucky, differ from Alabama in a one crucial way. Alabama never accepted federal assistance, offered under the Affordable Care Act, to expand its Medicaid program to cover people below 138 percent of the federal poverty level. That left many of the state's poor in a gap, too “rich” for Medicaid and too poor for health care subsidies meant for people who didn't qualify for an expanded Medicare program.
Speakers at the Hoover meeting said the work requirement was really an attempt to strip single moms of their insurance because nearly any paying job would disqualify them for Medicaid.
“Someone working in a cubicle probably came up with this, and thought it was a good idea, but they don't know what's really going on,” said RaSheda Workman, an organizer for the Black Belt Foundation.
Workman took state officials to task for holding a hearing in Hoover, not known for its high percentage of Medicaid customers. The city's poverty rate is 6 percent, according to the Census Bureau, its median household income $78,056. The meeting venue was a stone's throw from the Riverchase Galleria.
Still, speakers at the event seemed sympathetic to the problems of moms on Medicaid. Hoover resident Evonne West said she worked full-time at Alabama Power until she had triplets, some of whom had medical issues. She said she switched to part-time work as a Mary Kay consultant to accommodate a life of constant doctor appointments. West is on her husband's insurance, but she said a lot of single moms are in similar situations and need coverage.
West predicts “sicker families, sicker children” if Medicaid work requirement passes. pic.twitter.com/V7K4xkXJf7— Tim Lockette (@TLockette_Star) March 6, 2018
“This is not what we need as parents or caregivers,” she said. “This just won't work.”
Jefferson County resident Mary Michael Kelley said she worked at a local food bank until her son's medical problems forced her to leave work behind. She said most of the few people on Medicaid would like to work, if they could.
“There is a picture we have in our heads, I think, of what this population looks like,” Kelley said. “It is not what we think, and even if it is what we think, that shouldn't matter.”
Medicaid officials said Medicaid recipients caring for someone with a disability would be exempt from the work requirement.
Several speakers questioned whether there would be any support for parents who found work and then needed to find day care for children in their care.
Doug Hoffman, a former hospital administrator, said the loss of coverage would lead to unintended health care consequences later.
“Another way that people die from not having health insurance is not having access to mental health care,” Hoffman said. “This push to save dollars is going to have real consequences.”
Medicaid officials held a separate meeting Monday in Montgomery, which also drew a crowd largely opposed to the plan. Both meetings were advertised in newspapers in the state's largest cities, officials said.
The agency will accept written comments on the plan at PublicComment@medicaid.alabama.gov until April 2.