Health Policy Perspective: Medicaid and State Politics Beyond COVID
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Division of General Internal Medicine and Center for Health Systems Effectiveness, Oregon Health and Science University, OR, Portland, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; 3Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA; 5Division of General Medicine, University of Michigan, Ann Arbor, MI, USA; 6Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
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The COVID-19 pandemic is poised to drastically alter the Medicaid program. While state Medicaid programs are currently expanding coverage policies and enrollment to address acute public health needs, states will soon face significant budget shortfalls. These impending changes may renew partisan debates about restrictive policies like work requirements, which generally require beneficiaries to verify their participation in certain activities—such as employment, job search, or training programs—in order to receive or retain coverage. We argue that restrictive Medicaid policies are driven, to a great extent, by political party affiliation, highlighting the outsized role of partisanship in Medicaid policy adoption. To combat these dynamics, additional efforts are needed to improve community-informed decision-making, strengthen evaluation approaches to tie evidence to policymaking, and boost participation in and understanding of the political processes that affect policy change. J Gen Intern Med DOI: 10.1007/s11606-020-06117-1 © Society of General Internal Medicine 2020
COVID-19 pandemic is poised to drastically alter the T helandscape—and politics—of the Medicaid program. As the nation’s social safety net, Medicaid is expected to absorb many of the millions of newly unemployed, with states projecting higher spending and enrollment continuing into 2021 as a result.1 However, despite a temporary increase in Medicaid’s federal match rate to provide fiscal relief during the pandemic,2 states may soon face significant budget shortfalls and spending cuts even as demand for services grows. These economic realities and uncertainties may renew partisan politics around Medicaid, particularly around policies that restrict eligibility, increase cost-sharing, or limit enrollment. Received May 4, 2020 Accepted August 5, 2020
Many of these policies have been proposed previously via Section 1115 waivers, which provides the authority for states to diverge from federal Medicaid guidelines and pilot different approaches in coverage and care delivery. Nowhere, perhaps, has this political litmus test been more pronounced than with state-level adoption and implementation of Medicaid work requirements, which the Centers for Medicare and Medicaid Services (CMS) first approved in January 2018. Work requirements generally require beneficiaries to verify their participation in certain activities—such as employment, job search, or training progra
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