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Florida lawmakers want to require Medicaid enrollees to work

Another state is taking up the Trump administration’s offer.

Donald Trump and Rick Scott
Donald Trump and Florida Governor Rick Scott
James Leynse/Getty Images
Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

The Trump administration has opened the door for states to put new restrictions on their Medicaid programs, and Florida is stepping through it.

The state House is advancing a plan to introduce work requirements and charge most enrollees a nominal premium. From the Miami Herald:

The Florida House is moving ahead with a plan to force able-bodied Medicaid recipients to prove they are employed, participating in job training or searching for work in order to receive benefits, the same requirements the state puts on welfare recipients. The House also wants to require most Medicaid recipients pay $10 or $15 a month, depending on their income.

If Medicaid enrollees didn’t meet the work requirement or failed to pay their premium, they would lose coverage for a year.

"Medicaid eats up roughly 30 percent or so of our budget and just keeps rising tremendously," state Rep. Travis Cummings, a Republican, said in defense of the plan. "We just feel that when someone has a little skin in the game, even if it's just 10 bucks a month, that they may take that more seriously, that it can help the system function better and help control cost."

The federal government has historically spurned work requirements, but the Trump administration signaled last month that it is open to them. Kentucky, Arizona, and Arkansas are other red states looking to take up the administration on that offer.

The idea has a lot of problems, as Dylan Matthews recently explained. The majority of Medicaid recipients are elderly, blind or disabled, or children and pregnant women. Requiring them to work doesn’t make much sense. Of the able-bodied adults enrolled in the program, most of them already work. Those who aren't working tend to be sick, caring for a family member, in school, or unable to find work. Even conservative experts are dubious about the policy’s merits.

On paper, at least, the move would also make Florida’s Medicaid program one of the most restrictive in the country. The state has already refused to expand Medicaid under Obamacare, leaving nearly half a million of its poorest residents without health coverage. And its existing eligibility rules are very limited. From the Herald:

Florida already has one of the most restrictive Medicaid programs in the nation. It is open only to adults with dependent children, pregnant women, low-income seniors and people with disabilities.

For adults to be eligible, they must make less than $6,652 in annual income for a family of three, according to the Kaiser Family Foundation.

If the House clears the plan, it would head to the state Senate and to then Gov. Rick Scott’s desk. Joan Alker, a Medicaid expert at Georgetown University who follows Florida closely, told me that Scott would likely be amenable to the proposal, but the Senate is more of a question mark.