Moving Beyond Work Requirements for Medicaid – For People with Mental Health Conditions, the Expansion Must Remain in Place

While Mental Health America (MHA) supports the recent decision by the U.S. District Court for the District of Columbia to block the work requirements under Medicaid expansion in the state of Kentucky, MHA warns that it should not now be used to deny people with serious behavioral health conditions the Medicaid coverage to which they are entitled.

The June 29^th decision by Judge James Boasberg vacates the Trump Administration's approval of Kentucky’s HEALTH’s work requirements plan, sending the matter back to the Department of Health and Human Services (HHS) for further review. The judge ruled that the Trump Administration’s approval of work requirements – which the state calls community engagement— were “arbitrary and capricious,” because these unprecedented requirements “never adequately considered whether the plan approved for Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid.”

“MHA favors Medicaid expansion, but the Governor’s response to the judge’s decision blocking the work requirements should not be an excuse to deprive thousands of people with serious behavioral health conditions needed Medicaid coverage by rolling back Medicaid expansion,” said Paul Gionfriddo, president and CEO, MHA.

The state intended to exempt people with these conditions from work requirements, and states should work to make sure that all individuals with a serious mental illness are identified, covered, and exempted from work requirements. The ability to access treatment and supports before crisis – Before Stage 4 – without having to be considered fully “disabled” has been one of the most important outcomes of Medicaid expansion for people with serious behavioral health conditions.

The Kentucky waiver would have required all Medicaid recipients who were not exempt from work requirement to be engaged in 80 hours a month of “approved activities” that include working, volunteering, attending school, or caretaking.  Over half of those in the expansion population already meet that condition without a state mandate, notes Marcie Timmerman, Executive Director of MHA of Kentucky.

The waiver also required people to report their activity hours directly to the state.  “People living with mental health conditions, like many others in Kentucky, are unlikely to have the necessary internet access to report their activity hours, she explains. “The answer is not, as the Bevin administration has argued, for people without in-home internet, or without access to transportation, to use their ‘local’ library in a state where many rural counties have only one.” 

“If work requirements are struck down, expansion needs to remain to benefit people with behavioral health conditions, concludes Gionfriddo. “Medicaid is - at its core - a health insurance program, not a work program.”