Speakers at a public hearing today said a proposal by the Alabama Medicaid Agency to impose new work requirements on some able-bodied parents would be punitive, partly because those affected face major barriers to employment and would eventually lose their health coverage even if they got jobs.
They said the plan would mainly affect mothers who would need help with child care and transportation to leave the home and work, supports they said the state does not adequately provide.
Carol Gundlach, a policy analyst for Alabama Arise, said it was cruel to threaten mothers with the loss of health care if they don't climb over those barriers to get jobs. Alabama Arise is a coalition of organizations that advocates for low-income families.
Gundlach said there is a waiting list for subsidized child care and no reason to believe the state could absorb a demand for thousands more slots.
Speakers also questioned whether the proposal made sense financially because of new overhead costs affecting just a small slice of the Medicaid population.
"I simply don't see how the dollars work to make this possible," Gundlach said.
A Republican state senator who has supported work requirements said they appear reasonable and would promote personal responsibility.
Medicaid held the public hearing at Alabama Industrial Development and Training in Montgomery. A second public hearing is scheduled for Tuesday at 11 a.m. at the Hoover Public Library.
The hearings come at the start of a 30-day public comment period on Medicaid's request for a waiver from the Centers for Medicare and Medicaid Services.
The Trump administration encouraged states to seek work requirement waivers for Medicaid, which is one of the costliest programs for taxpayers in Alabama and other states.
Gov. Kay Ivey directed Medicaid Commissioner Stephanie Azar to seek a work requirement waiver for Alabama.
Ivey said the intent of the proposal is to save taxpayer dollars and reserve Medicaid services for those who need them.
In its public notice announcing the program, Medicaid said it will improve health outcomes and economic security for the affected families because of the benefits of work.
Medicaid says the plan will be similar to work requirements for Temporary Assistance for Needy Families, the cash welfare program, which serves far fewer people in Alabama than Medicaid. It generally requires 35 hours a week of employment related activities, or 20 hours a week for those with children younger than 6.
Under the Medicaid proposal, acceptable activities would include a job, job training, job search and readiness activities, school, GED classes, college or vocational school. Volunteer work also would qualify.
About one million Alabamians receive health care coverage from Medicaid, mostly children, the disabled and the elderly.
The new work requirements plan applies to a group called Parents or Caretaker relatives, about 74,000 of the Medicaid recipients in the state. They have very low incomes, no more than 18 percent of the federal poverty level. The monthly income cap for a family of four is $377.
Some people in the Parents or Caretaker Relatives program would be exempt from the new work requirements, including those with a disability, those 60 or older and those caring for a disabled child or adult.
After the exemptions, Medicaid estimates about 17,000 adults would be required to participate.
Six people spoke at Monday's hearing, five in person and one by phone. All six opposed the proposal.
Ashley Edwards, a social worker in Montgomery, said it's incorrect to say that parents and those taking care of relatives in their homes are not working; Edwards said parenting and caretaking are work.
Edwards said said social workers already face large caseloads and difficulties in helping find support services, like child care, for low-income parents trying to find work outside the home.
Linda Lee, executive director of the Alabama Chapter of the American Academy of Pediatrics, said the plan would force many parents who follow the rules and get a job into the "coverage gap." Their incomes would be too high for Medicaid but many would probably not have insurance through their employers and would not earn enough to qualify for premium tax credits on the Affordable Care Act Marketplace.
To qualify for premium tax credits, which help people afford insurance, they must make at least the federal poverty level, which is $25,100 for a family of four, more than some could expect to make on entering the work force.
Loss of Medicaid coverage for some adults would place an additional burden on hospital to provide care for the uninsured, Lee said.
Kimble Forrister, executive director of Alabama Arise, said he's concerned Medicaid hasn't done enough to analyze the real-life situations of those who would be affected.
"We're concerned that these folks face too many barriers to work like the need for child care and the need for transportation and the fact that the jobs just aren't there in some of our counties," Forrister said. "And so these folks will lose their Medicaid and get nothing.
"Another problem is, if they do get a job, then they make too much money to qualify for Medicaid, and they're kicked off. They took the job to qualify for Medicaid but getting the job disqualifies them. It's a Catch 22."
The plan does call for those who get a job and earn too much to qualify for Medicaid to keep transition coverage for six months.
Sen. Arthur Orr, R-Decatur, has proposed legislation requiring Medicaid to seek a work requirement waiver. Orr, who did not attend today's public hearing, commended Ivey on seeking the waiver. Orr noted that the Medicaid proposal had multiple options like job training, GED classes and volunteer work.
"I don't think a price tag can be put on the value of a person getting up, going to work, starting to support themselves and their families rather than staying at home, not willing to engage or improve themselves through job training, substance abuse counseling, whatever they need, and continuing their current state or condition in perpetuity," Orr said. "That does no one any good. And I think raising the bar and trying to nudge people to better themselves is a worthwhile policy goal."
Two Democratic candidates for office spoke at today's hearing. Robert Kennedy Jr., or Prichard, a candidate for Congress in Alabama's 1st District, noted that the program's first stated objective was to identify people eligible for employment opportunities and help them get job training. Kennedy wondered why that was not already being done.
Kennedy said he was worried about the message the proposal sent.
"It leaves me feeling as if we're trying to demonize poverty," Kennedy said.
Will Boyd, a candidate for lieutenant governor, said he did not support the plan. Boyd, who spoke by telephone conference, said parents and caretakers already have their hands full.
"I have great concerns about the way we move forward on his proposal," Boyd said.
Robin Rawls, spokeswoman for the Alabama Medicaid Agency, moderated today's public hearing and said the agency would take all the comments into consideration.
Medicaid is also accepting public comments by email. The agency has more information on its website.
This story was updated at 5:39 p.m. with comments from Sen. Arthur Orr, additional comments from Kimble Forrister and more information.