Work requirements don’t work, Medicaid expansion does

This post is part of a series of takeaways from working in the behavioral health space over the past year

In addition to pioneering reintegration of behavioral and somatic care, Virginia is also pioneering in another albeit paradoxical way. It is progressively expanding Medicaid coverage while simultaneously regressively imposing work requirements as a condition of eligibility for health insurance. The former policy is evidence-based; the latter is not. Maryland, where I worked, is an expansion state with no work requirements.

At the organization I led, there were many working patients and almost all of their care was reimbursed by Medicaid. Based on Medicaid eligibility requirements, the patients’ incomes would generally be less than 138% of the federal poverty level. Hundreds of working clients came in a bolus from 5a to 7a. There were bus drivers, accountants, nurses, construction workers, and many others.

If these working clients were to pay out of pocket, they would have to spend over half of their incomes on treatment. Without Medicaid expansion, the many of these clients would not have insurance and it would be more cost effective for an individual client to cop heroin on the corner than to pay over half of their salary for life-saving treatment.

Without Medicaid expansion, thousands more people would have died from opiate overdoses in Maryland. Thousands of deaths sounds like a numb statistic. My uncle’s singular death was a very painful reality.

Next post: Behavioral health needs, but isn’t ready for, value based payment