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Medicaid work requirements are becoming law—here's how providers can help maximize coverage for at-risk populations

June 14, 2018

    Last week, Virginia became the 33rd state to expand Medicaid under the Affordable Care Act, covering an additional 400,000 low-income residents. Expansion didn't come easy: After five years of effort, lawmakers were only able to pass the bill with a work requirement provision, making Virginia one of five states—joining Arkansas, Indiana, Kentucky, and Michigan—to add controversial work requirements to the entitlement. Introducing these provisions can negatively impact around 1.7 million beneficiaries, including those currently working blue-collar jobs.

    Care management enrollment for complex managed Medicaid patients

    Work requirements mean provider organizations must invest in workforce development—here's how

    Provider organizations are well aware of the impact that lack of insurance and socioeconomic instability have on patient outcomes and total cost of care. Some organizations already have programs in place to connect patients with financial benefits and entitlements—but in states with work requirement provisions, providers will have to go further.

    For population health leadership, this changing policy landscape incentivizes a greater investment into programming for community workforce development. Here are three major components shared by the most progressive workforce development programs:

    1. Target programs to low-income populations who face multiple structural barriers in securing employment. In addition to targeting individuals at risk of losing Medicaid coverage, the best workforce development programs prioritize those who face additional barriers to employment, such as returning citizens (i.e., those recently incarcerated). This tactic increases the participant pool, targets those more likely to fall through the cracks across non-health care institutions (e.g., legal services and the education system), and can prevent downstream clinical escalation.
    2. Offer access to high-quality, easily transferable job training for careers with clear growth trajectories. Providers have increasingly developed training programs that prepare community members for jobs in the health care field (e.g., community health worker training programs and career ladders). Job training equips program participants with new skills to advance in a health care field—while also giving providers easy access to a pool of trained candidates to fill open positions. To set participants up for openings, ensure that training programs teach skills related to the application process (e.g., resume writing and interviewing). Internally, outline a clear career ladder for entry-level positions to retain these candidates over a longer period.

    3. Be prepared to extend support beyond training to holistically support participants' social needs. Program participants won't be successful in job training or in long-term careers if they can't meet pressing social needs (e.g., no access to consistent child care). We spoke with one organization that relies on participants' coworkers to alert program leadership of any personal challenges that slow down their peer's performance. Leadership then works with participants to address any psychosocial barriers (e.g., a loss of housing or a break-up).

    Provider-sponsored workforce development programs are good options for organizations aiming to drive widespread economic health in their surrounding communities. And in states implementing workforce requirements for Medicaid beneficiaries, workforce development programs can make all the difference in whether or not patients get insured.

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