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The Journal Gazette

Sunday, June 02, 2019 1:00 am

Work rules put HIP recipients at risk

Fran Quigley

As of July 1, Gov. Eric Holcomb will require work reporting from many of the 400,000-plus Hoosiers who count on the Healthy Indiana Plan for their medicines and care.

Holcomb's health care leader tells us not to worry. “We have no intention of putting (HIP) members at risk,” Indiana Family and Social Services Administration director Jennifer Walthall says.

Yet that is exactly what work requirements will do to our most vulnerable Hoosier neighbors. If Holcomb understood the lessons of these four stories, he would stop his work requirements plan.

Todd Muow's story: Health care red tape leads to suffering and death. Anyone who has dealt with Indiana's public benefits programs knows they are already confusing and complicated. When work requirements are added to the red tape burden, decades of evidence from around the country shows that people fall off of programs as a result.

Each bureaucratic denial is not just a data point; it is a decision that can cause real suffering. In Iowa, quadriplegic Todd Muow died shortly after the state's Medicaid program cut him off of his successful home care regimen.

His case is one of hundreds in Iowa that have led to official complaints against a corporation and the state for wrongly denying care.

In California, 20-old Sarah Broughton died after a routine sinus infection was left untreated and spread to her brain. Broughton had applied for Medicaid multiple times, but her application was routinely denied or delayed. The day after she died, Broughton's parents received her approval for Medicaid.

D'Ashon Morris' story: Profit-seeking contractors cannot be trusted with health care. Holcomb is one of several governors who choose to contract out their state's Medicaid duties to private corporations. Indiana's hands-off approach leaves responsibility for the care of Hoosiers – and millions of taxpayer dollars – to private insurance companies and a large corporation that specializes in public benefits paperwork.

Often, corporations increase their profits by denying care. In Texas, young D'Ashon Morris was left permanently brain damaged when his Medicaid care was reduced to a dangerously low level.

That fateful decision saved money for the corporation Texas pays to manage Medicaid, a common enough occurrence that it triggered an award-winning year-long investigation by the Dallas Morning News called “Pain and Profit.” Similar privatizing arrangements have caused an outcry in states such as Iowa, where reduced care has led to lawsuits and complaints by both patients and providers.

Amber Thayer's story: Indiana's bureaucracy cannot be trusted with administering a work requirement. Holcomb's work-requirement plan is similar to the disastrous program recently rolled out in Arkansas. Before a federal judge ordered the program stopped, Arkansas kicked more than 16,000 people off of health care. Kentucky officials boasted that they plan to use similar work requirements to take health care away from 100,000 people.

Surveys showed that many of those kicked off in Arkansas likely were working or exempt but were tripped up by the red tape of the reporting process.

That result was not surprising; studies by the Kaiser Family Foundation and other researchers show that the vast majority of Medicaid enrollees who can work already do so. Others usually should be considered disabled or are caregivers, and thus exempt from the requirements.

Will eligible Hoosiers be able to qualify for those exemptions? Indiana's track record suggests many will not.

In Indiana, HIP's requirement for nominal payments, a departure from long-time Medicaid practice, had a devastating impact in its first two years. Nearly 60,000 Hoosiers were either blocked from coverage or kicked off because they failed to meet the demand for premium payments. For the same reason, another 287,000 of the poorest Hoosiers were downgraded to a more limited health care plan.

One of those affected was Amber Thayer of Indianapolis.

Indiana officials wrongly kicked Thayer off HIP as a result of administrative mistakes, preventing the homeless mother from seeking housing or a job. Instead, she had to spend each day cobbling together enough money for a single day's medication, then walk to the pharmacy with her infant daughter.

It took six weeks, multiple lawyers' help and two administrative hearings before the state and its contractors fixed their error. A new work requirement will mean that hundreds of thousands of Hoosiers will face new, additional barriers and inevitable administrative mistakes.

Adrian McGonigal's story: Work requirements can actually prevent work. Trump administration director of the Center for Medicare and Medicaid Services Seema Verma says the aim of work requirements is to “allow able-bodied, working-age adults to experience the dignity of a job.” That's not how Adrian McGonigal experienced it.

McGonigal's job at a food service company did not provide health insurance, so for four years he was able to get his prescriptions filled and go to the doctor, thanks to Arkansas' Medicaid program. McGonigal was able to follow the work requirement's reporting mandates at first. But he did not understand he was supposed to report in again each month.

One day, he went to refill his prescriptions and was presented with a bill for $800. The state had cut him off. McGonigal could not afford to pay for the medicine, so he fell ill and had to miss days of work. He lost his job.

If Holcomb's work requirements take effect, thousands of Hoosiers will endure what McGonigal did. Research shows that access to health care increases the likelihood of a person's consistently working. As the documented outcomes of the Affordable Care Act prove, people who obtain health care are more able to seek and maintain employment.

Healthy Indiana Plan work requirements will create a counterproductive red-tape mess that will hurt our sisters and brothers across the state. They will endure pain, unrelenting illness and even death. Holcomb holds the power to stop adding stories to this tragic list.

Fran Quigley is director of the Health and Human Rights Clinic at Indiana University McKinney School of Law and editor of the weekly publication Faith in Healthcare.