Medical Assistance recipients who are not working, job hunting or volunteering could lose their benefits under a measure Minnesota legislators proposed Monday.
Republicans in the House and Senate want to join other states that have added work requirements to their Medicaid programs, which in Minnesota is called Medical Assistance. President Donald Trump's administration announced in January that it would support states' efforts to set such conditions.
Legislators estimated about 125,000 people would be affected by the change, out of the roughly 1 million Minnesotans who receive Medical Assistance.
The proposal would require people to work or participate in community or public service — or some combination of the two — for 80 hours a month, unless they qualify for an exemption.
"I look at this as a very common sense and also compassionate piece of legislation," House Speaker Kurt Daudt, R-Crown, said. "I think what we want to do is protect these dollars for the people that need them the most."
Rachel Zimmer of St. Paul, who relies on Medical Assistance, said the legislation pits middle-class Minnesotans against the poor.
She has been unable to work for several years because of physical conditions and mental health issues, including anxiety and depression. Although the proposed bill would provide exemptions for those with disabilities, Zimmer is concerned that new rules could cut off her health coverage because she is "not quite disabled enough."
"They think that people are just lazy and don't want to work. That is a big myth," Zimmer said. "There are a lot of conditions that people have that makes it very difficult for them to work."
The legislators who rolled out the plan emphasized that it includes many exemptions for vulnerable individuals. People who are disabled, medically frail, older than 60 or enrolled in school are among those who would not have to comply.
Primary caregivers for someone who is younger than 6 years old or incapacitated would also be exempt, under the Senate bill. A House bill, which has not yet been introduced, would exempt primary caregivers of a child under 18, a House GOP spokesman said.
Minnesota has more jobs than job seekers, said Sen. Michelle Benson, R-Ham Lake, and this is a good time for people to move from Medical Assistance to an employer's insurance program or independent coverage. If the labor market falters, the bill states the Department of Human Services commissioner can modify or temporarily suspend the work requirement.
"I look at this as an opportunity for people to get on board with the growing economy and start fulfilling their highest potential," Benson said.
However, Dr. Danielle Robertshaw at Hennepin County Medical Center in Minneapolis says a lot of her patients on Medical Assistance want to work, but they first need the medical and social support that the government insurance program provides.
"From a medical standpoint I would be very concerned for my patients," said Robertshaw of work requirements. "Taking away access is the least affordable way to get them to work."
Many patients have not received primary care regularly until they entered the Medical Assistance program, leaving them with a complex combination of chronic diseases, mental health diagnoses or substance abuse problems.
"The ability to access care, including mental health, medical and social service support, is key to getting people to be stable enough in order to access work," Robertshaw said.
Several DFL lawmakers also voiced their opposition to the proposal Monday.
Rep. Jennifer Schultz, DFL-Duluth, called it "cruel and misguided" in a statement. She said it goes against the intent of Medicaid — to help vulnerable people who would otherwise fall through the cracks. An individual must make less than $16,039 annually to qualify for Medical Assistance.
Minnesota expanded Medical Assistance eligibility in 2011. Schultz said the legislation would reverse the progress Minnesota has seen on insuring more people.
Daudt said the number of people on Medical Assistance has grown dramatically in Minnesota since 2011.
"That is something that is wholly unsustainable and if we ignore that, we are headed for a crisis in the state budget," he said.
DFL Gov. Mark Dayton did not immediately respond to the proposal. Spokesman Sam Fettig said Dayton is reviewing it with commissioners and staff and will have more to say soon.
The proposed legislation did not include a specific framework for how to monitor compliance.