A proposal to force people on Medicaid to verify that they work or volunteer at least 20 hours a week could cost Minnesota counties and the state tens of millions of dollars in extra staff time and systems to track compliance, creating a costly and complex bureaucratic nightmare. It would create significant barriers for Minnesotans with disabilities to get the health care and supports they need. It would also make it more difficult for people to find and retain employment.

Medicaid, known as Medical Assistance in Minnesota, covers about one million people here. More than half are children. Lawmakers said they would exempt children, the elderly, pregnant women, people in treatment for substance abuse and those too ill to work. People with disabilities would also be exempt.

Anyone else working, seeking work, in school or training programs, or doing volunteer work for at least 80 hours per month, looking for work, in school or a training program, or doing community volunteer work for at least 80 hours a month would be allowed to keep their health care coverage. But the proposed law would require monthly reports to county caseworkers, starting in 2020. Failure to report would mean termination of Medicaid coverage.

Supporters contend that the Republican-driven bill is cost-effective and helps get people back to work in a time of labor shortages. They claim that Minnesota’s Medicaid programs, Medical Assistance, discourages able-bodied people from working. The measure narrowly passed through House and Senate committees before the Easter/Passover break, with votes hewing to party lines.

Gov. Mark Dayton has said he would veto the bill when it hits his desk. But it’s possible the measure could be wrapped up in a bill with other proposals, presenting a challenge to the governor.

Disability advocates, health care providers and people who rely on Medicaid are speaking out against the proposal. They contend it could be very costly and complicated to administer and that it could force people off of the health care they need. Workforce training programs could be adversely affected. Uncompensated health care, which is already a huge problem in some counties, could further increase.

County officials from around the state agreed, saying they’d have to raise property taxes or cut other services to cover the program. Hennepin County Commission Linda Higgins noted that her county would need 250 more workers at a cost of at least $17 million.

The Minnesota Department of Human Services also faces additional costs, estimating that 65 staff members would
have to be added. The state costs of administration could hit $7 million by 2021. Poignant testimony from people who would be adversely affected by the policy dominated committee hearings and a This is Medicaid-sponsored news conference on the proposal in late March. Those who could be affected talked about their desire to work and be active in their communities, but how difficult that can be when disabilities and chronic health conditions interfere.

This is Medicaid members outlined obstacles for people who could lose health coverage if they don’t fall into one of the exemption categories. One huge concern is for people with disabilities who lack a disability certification. Others who could be adversely affected include people with mental illness, people who live with fetal alcohol syndrome, those in treatment for cancer and other illnesses, the homeless and others who may not fit into an exemption category. Concerns were also expressed that the monthly reporting requirements could be too onerous.

Sue Abderholden, executive director of the Minnesota chapter of the National Alliance on Mental Illness, testified that the bill could cause further problems for people with mental illness. People with mental illness sometimes don’t have the ability to work. That in turn could force the loss of needed health care benefits.

Shauna Reitmeier, CEO of Crookstonbased Northwestern Mental Health Center, said the change would cause undue stress for her agency’s clients. “An arbitrary line is being drawn about who is worthy and who is not worthy of getting health care.”

Military veteran Willie Riley told legislative committees that Medicaid provides needed care while he works. He lives with several medical conditions and gets no health benefits from his jobs Losing Medicaid if he is unable to work would be “devastation.”

“I was willing to protect my country,” Riley said. “Now I ask you to protect me.”