Bills would impose work requirements for Medicaid in Alaska

Alaska State Capitol Building
Alaska State Capitol Building

By BECKY BOHRER, Associated Press

JUNEAU — Some Alaska lawmakers want to require Medicaid recipients to work in order to receive their benefits.

Two bills introduced in the Legislature would impose work requirements, something one of the sponsors, Senate President Pete Kelly, said should be seen as a “privilege” and not a punishment.

The bills in the House and Senate have been introduced amid concerns with the growth of the Medicaid program and costs.

Average monthly Medicaid enrollment in Alaska grew by 23 percent from fiscal year 2016 to fiscal year 2017, which ended June 30, according to the state health department. That figure includes traditional Medicaid, which provides coverage for low-income pregnant women, children and people who are disabled, and the expanded Medicaid program, which covers lower-income adults not previously eligible for coverage.

Over the objection of some lawmakers, Gov. Bill Walker, an independent, expanded Medicaid in 2015 to cover more lower-income Alaskans. So far, more than 40,000 Alaskans have been covered by the expanded program.

State health commissioner Valerie Davidson has cited the state’s recession as a reason for the increase in overall enrollment.


The U.S. Centers for Medicare and Medicaid Services in January issued guidance allowing states to pursue work or “community engagement” requirements to see if they lead to individuals obtaining long-term employment or improved health outcomes. States would have to seek a special Medicaid waiver to test the idea.

So far, waivers have been approved for Kentucky and Indiana, with requests by other states pending, according to the Kaiser Family Foundation.

Robin Rudowitz, associate director of the foundation’s Program on Medicaid and the Uninsured, said the guidance represents a shift from prior federal administrations that took the position that work requirements did not promote the objectives of Medicaid. The objective of the Medicaid program is to provide coverage to low-income people, she said.

States in the past generally have used waivers to promote and expand coverage, not to restrict it, she said.

The bills pending in the Alaska Legislature would require that a person work, actively seek work, participate in a school or training program intended to lead to a job, volunteer or be involved in subsistence activities for at least 20 hours a week.

The measures include exemptions for children, those 65 or older, those who can’t work for medical reasons and caretakers of a relative who has a disability and needs constant care, among others.
The federal agency said individuals compliant with or exempt from work requirements for certain aid programs, like food stamps, would be considered compliant with Medicaid work requirements.

Davidson recently questioned how much a state monitoring program would cost and whether it would save any money.

Katie Marquette, a state health department spokeswoman, said most Alaskans enrolled in Medicaid are children, retirees, people with disabilities or people living in working households. She said the department is reviewing the federal guidance.

House majority members on Tuesday reacted coolly. The House bill, sponsored by minority Republican Rep. Chuck Kopp of Anchorage, has been assigned to three committees, suggesting it could have difficulty advancing.

Kopp said the state has done a good job of providing a safety net for people who need coverage but said his bill is about “helping people get back on their feet.”

He said it could help cut down on fraud and he thinks it could be implemented with existing resources.

Kelly, a Fairbanks Republican, has been critical of the Walker administration’s handling of Medicaid, saying it has shown a willingness to grow the program “at all costs” and has encouraged people to sign up.

Alaska lawmakers in 2016 passed legislation aimed at controlling Medicaid costs.

“But I don’t know that any bill that you’re going to pass is ever going to compensate for an administration that is hell-bent on expanding Medicaid,” Kelly said earlier this month.