- Posted by EmpowerNonprofit
- On January 31, 2018
Kentucky’s Medicaid waiver requiring recipients to be employed has been approved by the federal government. This this is first example of tying Medicaid eligibility to a job. Several more states are expected to follow suit. Proponents say they’ve empowered recipients by asking them to take more responsibility for their health. Opponents have responded that it’s time to give people help not barriers to receiving Medicaid and other forms of life-saving assistance.
This disheartening development comes despite Kentucky being cited as an Affordable Care Act success story. Its Medicaid expansion had reduced the percentage of uninsured adults in the state from 16.3 to 7.2. But Matt Bevin, who campaigned on an anti-ACA platform, was elected governor in 2015. He decided to use the 1115 waiver process to downsize the state’s Medicaid expansion. Studies estimate that the work requirement and other waiver-induced changes will push 95,000 Medicaid recipients off the rolls in Kentucky.
When this story broke, I immediately thought about a man I once knew whom I’ll call “Ray.” He had spent several years homeless, much of the time living in illegal camps. Ray’s story—and the story of many homeless people—is at least in part about the potential healing power of jobs. A steady job, especially one that has benefits, can provide income, access to health insurance and a strong sense of purpose. While doing street outreach, I’ve talked to people whose first question for me was, “Can you help me get a job?” Yet the relationship between homelessness and jobs is not a simple one.
I remember a story Ray once told me. He was sitting and talking with about 10 folks who lived together in a homeless camp located near a city street. A car slowed down and the driver yelled, “Get a job, you bums!” before roaring off. Ray looked around the group and realized that at least six of people in the circle were employed. A couple worked multiple jobs. Yet here they were sleeping in tents, squatting on an empty lot. Why? Barriers.
Homeless individuals face all kinds of barriers. Among the group that Ray lived with, some couldn’t afford even the cheapest local apartment rent on their low wages. Others lacked the savings for a deposit. Some had rent arrearages and unpaid debt that always turned up on housing application credit checks.
Yet the news about Kentucky made me think about Ray’s particular barrier: he suffered from severe persistent mental illness. He was an intelligent man and at one time had worked in the IT field. But his illness manifested itself in behavior that left him unable to hold a job and made him unwelcome at the local emergency shelter.
I’ve known many other people living in similar circumstances. Like Ray, some had untreated mental illness. But others suffered from the effects of chronic physical illnesses, traumatic brain injury or substance abuse. Unfortunately, the Rays of the world aren’t employable—at least in their current condition. What they need instead of a job is treatment for their various ailments, as well as a safe place to live.
Fortunately, Ray’s story has a happy ending because he was living in a state that maintained low barriers for receiving Medicaid. I first met him while visiting the apartment he’d moved into as a participant in a barrier-free permanent supportive housing program. Along with housing, the program gave Ray access to mental health treatment and supports—all paid for by Medicaid. As his mental health stabilized, he started talking about someday resuming his career, maybe after returning to school to update his skills. Medicaid made this dream realistic because it also paid for Ray to work with a supported education and employment counselor.
Ray’s story offers a lesson that Kentucky and other states need to consider: many people need Medicaid to get a job, not vice versa. People have plenty of barriers that prevent them from being healthy, housed and living independently. States need to continue their efforts to help people overcome barriers, not create new ones that make their lives even more challenging.