The failure of the Republican repeal and replace bill for Obamacare means that governors who want to change Medicaid requirements have to ask the federal government for permission. Walker is readying a request to let his state screen Medicaid applicants for drug use, which he plans to make public on April 19 and then send to the Centers for Medicare and Medicaid Services by the end of May.
If Walker succeeds, Wisconsin would be the first state to drug test Medicaid applicants.
Walker’s proposal would require childless, able-bodied adults living below the poverty line to answer questions about illegal drug use. If their answers identify them as suspected of using drugs, they’ll be required to undergo a drug test in order to get Medicaid benefits. Failing to take it will make them ineligible for at least six months. Those who test positive would have to receive treatment.
Walker is proposing to allow Medicaid to cover residential drug abuse treatment for these applicants. But his regime would deny health care coverage to anyone who couldn’t or didn’t want to take a test to get benefits. Denying health care to someone who may have a drug abuse problem isn’t likely to help get them assistance or any healthier.
If existing drug testing regimes for welfare, which allows states to impose such changes on their own, are any guide, that will be the more likely outcome. According to experts, there are more people who are denied welfare benefits because they don’t take the drug tests than those who are denied for a positive result. In Missouri for example, 407 people were tested while 627 either refused to get tested or didn’t follow up on it in 2014.
Some applicants may object to being forced to pee into a cup to get public benefits. But it may also simply be that they aren’t able to follow up and complete a test. Doing so could require arranging additional transportation, time off of work, childcare, or other logistical challenges in order to show up for a second visit to their state agency.
Walker thinks Trump’s administration is likely to allow him to implement drug testing. Tom Price, secretary of the Department of Health and Human Services, and Seema Verma, the head of the Centers for Medicare and Medicaid Services, sent a letter to governors welcoming proposals for “training, employment and independence.”
But his proposal has no evidence to back it up. Among the ten states that currently screen applicants to the Temporary Assistance for Needy Families welfare program, just 321 people tested positive. In more than one state, not a single person tested positive. Overall, the positive drug test rates are lower than the national drug abuse rate.
Yet these states still wound up spending nearly $2 million, collectively, to implement drug testing regimes over two years. That’s money that could otherwise be spent on benefits for the needy.
Walker is proposing other changes to Medicaid as well, such as requiring single adults to pay premiums and copays for emergency room visits. Those who prove they don’t engage in risky behaviors such as drug and alcohol use, smoking, obesity, and failing to wear seat belts wouldn’t have to pay. He also wants to impose work requirements on able-bodied recipients between the ages of 19 and 49, which is likely to result in vulnerable people losing their health insurance.
All told, his changes to the program would cost an estimated $48 million a year to administer.
Author: Bryce Covert