Kansas Gov. Kelly floats work requirements for Medicaid expansion in bid to win GOP support
Kansas Democratic Gov. Laura Kelly on Thursday offered a Medicaid expansion plan that would ask hospitals to provide funding and includes a work requirement — long a must-have item for many Republicans to support expansion.
Kelly’s proposal marks an aggressive effort to win over Republican lawmakers who have opposed expansion in the past by putting forward a proposal designed to address their concerns about costs and expanding government aid.
“We’re going a step further to meet Republicans in the middle, putting forward a plan that would cut healthcare costs, create jobs, and grow our economy — all at no additional cost for Kansas taxpayers,” Kelly said in a news release Thursday afternoon, as she announced the proposal at Holton Hospital.
But the addition of work requirements in Kelly’s proposal drew immediate concerns from some advocates on Thursday, who argued the move won’t incentivize people to secure jobs and would instead leave vulnerable Kansans without coverage.
“It comes across as a policy that does more harm than it does good,” April Holman, executive director of the Alliance for a Healthy Kansas, told The Star. ”We support expansion, and we are always going to be willing to work with any policymakers who have an interest in making expansion a reality. There are just some provisions that are easier to compromise on than others. And the work requirement is one of the most difficult.”
Medicaid expansion could provide health coverage to upwards of an additional 150,000 Kansas residents who sit just above the poverty line. Every state bordering Kansas has expanded, leaving Kansas as one of only 10 states without the broader coverage.
Kelly has made expansion a core part of her political identity and has proposed it every year she has been in office. But Republican leaders, with a few exceptions, have largely resisted her plans, citing fears over costs and an expanded welfare state.
Kansas House Speaker Dan Hawkins, a Wichita Republican, is one of the staunchest opponents in the Legislature.
“While I appreciate the Governor’s newly found support for work requirements for welfare benefits, this is nothing more than smoke and mirrors because Governor Kelly most surely knows that the Biden administration has not approved any Medicaid work requirement and proactively revoked every single work requirement approved previously,” Hawkins said in a statement Thursday.
In practice, efforts to implement work requirements in other states have often been caught up in litigation or bureaucratic wrangling. The Biden administration opposes work requirements, but former President Donald Trump supported them. If a Republican wins the 2024 presidential race, the new administration will likely again pursue work rules.
States with expansion pay 10% of the costs and the federal government pays 90%. Expansion could draw $1 billion or more a year in federal aid, depending on how many people enroll.
Kelly’s office says the new plan is revenue-neutral to Kansas because a hospital surcharge, along with drug rebates and other cost savings, will help cover the state’s share. The proposal will be revenue-neutral to the state, according to her office.
“Medicaid Expansion is important for all hospitals in Kansas,” Chad Austin, president and CEO of the Kansas Hospital Association, said in the release. “Medicaid Expansion will bring tremendous benefits to Kansas citizens, the Kansas economy and the Kansas health care system.”
The proposal includes a work requirement, saying able-bodied adults must provide documentation showing they’ve been employed for the past 12 months, including a pay stub and tax papers.
There are several exceptions including for: caregivers, veterans, full-time college students, individuals experiencing homelessness, people with a permanent disability or who are mentally or physically unfit for employment, residents who volunteer at nonprofits for 20 hours a week, parents of children under the age of 18, and others.
Applicants must provide proof of employment or community engagement at the time of entry and renewal each year, Kelly said during her announcement on Thursday, adding, the “work requirement will make sure that no one is taking advantage of the program without doing their part.”
“Many of my colleagues across the aisle have expressed concerns about people taking unfair advantage of Medicaid were it to be expanded in Kansas—that it will allow able-bodied adults to choose not to work,” Kelly said in prepared remarks. “First of all, those concerns are simply unfounded: 73% of uninsured people in Kansas are working but have jobs in restaurants, day cares, hotels—where health insurance is not offered.”
But Holman worries the work requirements would be an overly burdensome barrier to entry, that could result in the loss of coverage for Kansans who would otherwise benefit from expansion.
“When it comes to hoops and red tape, that is never helpful in getting more people in the program,” she said.
Cindy Samuelson, with the Kansas Hospital Association, said, “there’s a little bit of everything in this proposal that not everybody is happy about. But everybody’s got to put a little on the table in order to get a bipartisan piece of legislation like this passed.”
Some Republicans have long seen work requirements as key to any expansion plan, arguing they could encourage residents to secure work and eventually move off of government aid. But Democrats in the past have resisted them.
“This proposal addresses a lot of the concerns I’ve heard from Republican colleagues by including a work requirement and multiple funding streams to ensure Kansas taxpayers won’t foot the bill for Medicaid expansion,” said Republican state Sen. John Doll, a moderate from Garden City. “I urge my Republican colleagues to join me in supporting this bill to ensure our rural hospitals stay open, to cut healthcare costs and lower taxes, and to get affordable healthcare to more working Kansans.”
Kelly’s proposal also provides coverage for individuals who are incarcerated, including after they are released.
“For too long, county jails have been shouldering the burden of providing medical care to inmates at their own expense,” Kelly said in her remarks. “They have faced the catch-22 that, while providing that coverage is painfully expensive, it also contributes significantly to reducing recidivism.”
The Star’s Katie Bernard contributed reporting.
This story was originally published December 14, 2023 at 2:00 PM.
