Michigan House passes Medicaid work rules. May soon go to governor.

Update: Have an opinion on Michigan’s Medicaid work rules? Weigh in quickly.

Republicans in the Michigan House on Wednesday moved quickly to require Medicaid recipients to meet work requirements to keep health-care benefits, joining multiple states considering similar plans.

The bill now goes to the Michigan Senate to vote in the House changes, before presumably heading to Gov. Rick Snyder’s desk for his expected signature. The revisions are the result of a compromise reached between Snyder and the bill sponsor, Sen. Mike Shirkey, R-Clarklake.

The House vote — which comes about a week before lawmakers break for the summer — may affect the health care coverage for hundreds of thousands of low-income Michiganders.

The bill that passed the House by a vote of 62-47 is a pared-back version of Senate Bill 897, that first cleared the Senate in April.

Among the changes approved Wednesday by a House committee, and later adopted by the full House, make the proposed work requirements less stringent than in earlier versions in the following ways:

• Volunteering and time spent looking for work now would also be allowed to count toward the work requirement.
• The required number of hours to be worked were lowered from an average of 29 per week to 80 per month (roughly 20 hours a week), to account for flexibility in some part-time workers’ schedules.
• A controversial exemption from the work rules for people who live in counties with unemployment rates of at least 8.5 percent also was stripped from the bill. The exemption drew national criticism from Democrats and advocacy groups because it would have provided an exemption to many rural, mostly white and Republican-voting counties, while holding poor, mostly black and Democratic-voting cities such as Detroit and Flint to the more stringent work requirements.
• Enrollees will not have to meet work requirements for three months in a given year. After that, they would lose their health coverage for at least one month until they again comply. Previous versions of the bill would have kept Medicaid recipients who fell short out of the program for a year.

Four states — Indiana, Kentucky, Arkansas and New Hampshire — have had waivers to create work requirements for Medicaid recipients approved by the federal Centers for Medicare and Medicaid Services. Seven other states have pending waivers, while more states, Michigan included, are still debating legislation.

The bill adopted Wednesday also would require participants in Michigan’s Medicaid expansion program, known as the Healthy Michigan Plan, to pay more in cost-sharing and maintain healthy behaviors to keep receiving benefits.

It would require Healthy Michigan Plan beneficiaries earning between 100 percent and 133 percent of the federal poverty level, and who have been enrolled in the program for at least 48 months, to pay 5 percent of their income toward their benefits. That’s an increase from 2 percent today.

They also would need to meet benchmarks for healthy behavior that grow increasingly tougher over time, so as to incentivize people to continue to adopt healthier lifestyles.

New Healthy Michigan enrollees would continue to pay 2 percent of their income toward premiums until they are enrolled for 48 months.

And it would add triggers to end the Healthy Michigan program, depending on whether the federal government signs off on the waiver the state would need to impose the work requirements.

The nonprofit Center on Budget and Policy Priorities, in a new analysis, said those triggers could put all of the nearly 700,000 people who receive health care through Healthy Michigan at risk of losing coverage, regardless of the work requirements.

Snyder spokeswoman Anna Heaton would not confirm whether the triggers inserted into the latest version of the bill were among items the governor negotiated with Shirkey; Gideon D’Assandro, spokesman for House Speaker Tom Leonard, said they were.

Heaton would only say: “We are continuing to work with our legislative partners in both the House and the Senate as the bill moves through the process.”

Republican lawmakers, led by Shirkey, say the work rules are needed to help more Michiganders enter the workforce and ease a talent shortage many employers face.

But the changes weren’t enough to satisfy opponents of the bill — namely, Democrats and groups representing vulnerable residents and health organizations — who continue to argue that Medicaid was never intended to be a workforce development program.

“As we have been saying all along, no exemptions or amendments will make this a good bill,” said Gilda Jacobs, president & CEO of the Michigan League for Public Policy, which advocates for policies that support vulnerable residents and families, in a statement.

Among its problems, she said: It does not include additional funding for transportation or child care to help adults enter the workforce or increase their work hours. And it perpetuates a myth, she said, “that people with low incomes are the cause of our state’s problems.”

“We applauded the governor and his strong opposition to this bill when it passed the Senate, but the changes in this bill are still not a ‘reasonable nor responsible change to the state’s social safety net,’” Jacobs said in a statement.

“We encourage the governor to examine this proposal more closely and the harmful impact and unintended consequences it will have on people with disabilities, parents and those with chronic health conditions, as well as others. This bill does one thing: it takes health care away from some of our state’s most vulnerable residents.”

One Republican, Rep. Martin Howrylak, of Troy, joined Democrats in opposing the bill in the House.