Like all states that expanded Medicaid under the Affordable Care Act, Nevada is currently struggling to manage its growing Medicaid program, which could soon overwhelm the state’s budget. Daniel Honchariw, a policy analyst at the Nevada Policy Research Institute points out in a Reno Gazette Journal opinion article that about 20 percent of Nevada’s residents, around 600,000 people, are enrolled in Medicaid, imposing an annual per-capita cost of about $5,700.
According to a November 2017 study by Nic Horton and Jonathan Ingram of the Foundation for Government Accountability (FGA), 60 percent of Nevada’s able-bodied Medicaid enrollees who signed up because of the state’s expansion did not work a single hour in 2015.
Adding a work requirement for those who are physically able has proven to be popular with the public. According to a recent Rasmussen Reports national telephone and online survey, 64 percent of American adults think childless, able-bodied adults in their state should be required to work as a condition for receiving Medicaid, while just 22 percent disagree. Fourteen percent are not sure. The survey was conducted on January 14–15, 2018, by Rasmussen Reports. The margin of sampling error is +/- 3 percentage points with a 95 percent confidence level.
In January 2018, Kentucky became the first state to have a Medicaid waiver approved by the Centers for Medicare and Medicaid Services (CMS) that includes major reforms like work requirements. Kentucky’s waiver allows the state to require all “able-bodied working age adult members without dependents” to meet certain work requirements, undergo job training, or perform volunteer community service in order to continue receiving Medicaid benefits.
When other entitlement programs implement work requirements they have been successful at reducing poverty by encouraging work and raising self-reliance. One example of successful work requirement reform is Kansas’ recent inclusion of work requirements in its welfare system. In a July 2017 report from FGA, Nic Horton and Jonathan Ingram examined Kansas’ welfare reforms and found they caused individuals to reenter the labor force. They also determined the incomes of Kansas families exiting the Temporary Assistance for Needy Families program (TANF) increased substantially, more than doubling in the first year.
According to the FGA study, as of 2017, Kansas families who left TANF are now earning $48 million more per year than they had while receiving cash assistance. The new incomes of those leaving the welfare system increased 104 percent in one year, $20 million more than they had while on welfare. Four years after the reforms, these individuals’ incomes had increased by 247 percent.
Several states – including Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin – have submitted waivers to CMS to implement Medicaid overhauls that include reforms like work requirements and cost sharing.
Building on Kentucky’s waiver as a model, Nevada should pursue a waiver incorporating work requirements into its Medicaid program. This would be a good first step toward limiting the rising costs of Medicaid and helping more people move from government dependency to self-sufficiency.
The following documents examine Medicaid reform in greater detail.
Don’t Wait for Congress to Fix Health Care
In this Policy Brief, Heartland Senior Policy Analyst Matthew Glans documents the failure of Medicaid to deliver quality care to the nation’s poor and disabled, even as it drives health care spending to unsustainable heights. Glans argues states can follow the successful examples of Florida and Rhode Island to reform their Medicaid programs, or submit even more ambitious requests for waivers to the Department of Health and Human Services – a suggestion the Trump administration has encouraged.
States Can Take Control of Health Care Reform
This Policy Brief by Daniel Honchariw, a policy analyst at the Nevada Policy Research Institute, analyses several potential changes to Medicaid and recommends patient-oriented solutions that are possible within the context of the existing law. It also outlines changes that state officials can make on their own, without federal input.
The Future of Medicaid Reform: Empowering Individuals Through Work
In this paper, Nic Horton and Jonathan Ingram of the Foundation for Government Accountability examine the problems created by Medicaid in the states and how they are in need of reform. Horton and Ingram argue states should pursue common-sense work requirements for Medicaid.
Work Requirements Are Working for Kansas Families: How Welfare Reform Increases Incomes and Improves Lives
In this study, Nic Horton and Jonathan Ingram of the Foundation for Government Accountability examine Kansas’ welfare reforms and how recipients fared after leaving the program. Their results found the reforms have led to more employment, higher incomes, and less dependency on government services.
The Power of Work: How Kansas’ Welfare Reform is Lifting Americans out of Poverty
In this study published by the Foundation for Government Accountability, Nic Horton and Jonathan Ingram examine Kansas’ welfare reforms and the effect they have had on food stamp enrollment. “With no welfare work requirement or time limit, just one in five able-bodied adults on food stamps worked. Nearly 93 percent of them were in poverty, most in severe poverty. Since implementing work requirements and time limits, the number of able-bodied adults on food stamps has dropped by 75 percent,” the authors wrote.
Research & Commentary: States Pursue Work Requirements for Medicaid
In this Research & Commentary, Senior Policy Analyst Matthew Glans examines efforts by several states to add work requirements to their Medicaid programs. “Implementing Medicaid work requirements would be a good first step for Medicaid-expansion and non-expansion states toward helping to limit the rising costs of Medicaid,” Glans wrote.
Research & Commentary: Why Arkansas’ Medicaid Rollback Could Be a Model for Expansion States
In this Research & Commentary, Senior Policy Analyst Matthew Glans examines Arkansas’ rollback of its Medicaid expansion program and discusses how other states could follow its lead. “States that have not expanded should avoid doing so, but for states that have expanded Medicaid, Arkansas’ reforms could be a good model for limiting the growth and cost of Medicaid expansion. Other states should take advantage of the waiver process while there is an administration in the White House willing to approve reform-minded Medicaid changes,” wrote Glans.
The Personal Health Care Safety Net Medicaid Fix
This article by Justin Haskins, Michael Hamilton, and S.T. Karnick of The Heartland Institute outlines a proposed reform plan for Medicaid, the Personal Health Care Safety Net Medicaid Fix. The authors say their Medicaid Fix would expand patient choice and give each Medicaid enrollee real money, not false promises, in the form of a personal safety net that would empower even the poorest of families to take care of itself and give more than 70 million Americans access to the private health insurance market.
The Oregon Experiment—Effects of Medicaid on Clinical Outcomes
This article from The New England Journal of Medicine examines Medicaid outcomes in Oregon. Oregon gave researchers the opportunity to study the effects of being enrolled in Medicaid (compared to being uninsured) based on data from a randomized controlled trial, the “gold standard” of scientific research. The results showed no improvement in health for enrollees, but it did reveal better financial protections for patients and increased medical spending.
Why States Should Not Expand Medicaid
Writing for the Galen Institute, Grace-Marie Turner and Avik Roy outline 12 reasons states should not expand Medicaid and should instead demand from Washington, DC greater control over spending to better fit coverage expansion to states’ needs, resources, and budgets.
Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database.
If you have any questions about this issue or The Heartland Institute’s website, contact John Nothdurft, The Heartland Institute’s government relations director, at [email protected] or 312/377-4000.