TennCare work requirements would cost taxpayers nearly $19 million each year, experts say

Requiring people to work in order to keep government health insurance will hit low-income Tennessee parents, caregivers and children especially hard and cost the state more money than it saves, a panel of experts said Tuesday. 

The proposed new work requirements were submitted to the federal government in December. They will require able-bodied TennCare recipients with children over the age of 6 to get a job, take classes or volunteer 20 hours each week.  

The new requirements will cost taxpayers nearly $19 million each year, even factoring in $3.6 million in savings from an expected ten percent who will lose TennCare coverage for failing to meet the new rules, according to an analysis by the state's fiscal staff.

Most of those new costs are tied to the bureaucracy required to keep tabs on whether people are meeting the new rules.

"By every objective economic standard, the policy being put forward here is harmful and will worsen outcomes," said Matt Harris, economics professor at the Boyd Center for Business and Economic Research at the University of Tennessee.

Work requirements in Arkansas

Arkansas has already implemented a similar policy and in the first five months 18,000 people lost access to Medicaid. 

The Arkansas rules snared those who were otherwise willing and able to work in a bureaucratic tangle that cost them benefits, according to Loretta Alexander, health policy director at Arkansas Advocates for Children and Families.

Alexander cited examples from Arkansas' roll-out: a 40-year-old man who doesn't own a computer or smart phone and lacks transportation to the public library to fill out the required electronic forms proving he worked. Once he lost Medicaid, the man also lost his job, because his health failed without regular medications he could no longer afford.

Others lost Medicaid because they had moved and, when letters were returned undelivered to the state's Medicaid program, their coverage was ended. 

Tennessee's work requirements apply to a broader range of individuals, including parents and caretakers of children over six years old. In Arkansas, the requirements exempt parents with children 18 and younger. 

RELATED:Caregiver, health care advocates fear impacts of TennCare work requirement proposal

Backers of the work requirements call it a pathway for people to lift themselves out of poverty while still providing support. Enacted before Gov. Bill Lee was elected, the new governor also supports the measure.

Joan Alker, executive director of Georgetown Center for Children and Families, said the work requirements would be especially harsh for Tennessee parents and children. 

Some 77 percent of TennCare recipients subject to the new work requirements are mothers, she said. The federal government does not require states to offer childcare or transportation assistance to help these mothers fulfill the requirement, she said.

Based on the proportion of Medicaid recipients who lost coverage in Arkansas, 68,000 Tennesseans could lose access to TennCare, according to an analysis by Alker and her colleagues at Georgetown. 

"This really is a very high stakes proposition for Tennessee's children and their parents," she said.

TennCare officials previously disputed the Georgetown figures, saying they were far too high, but have not provided their own estimates of how many could lose coverage under the new work rules.

Women fleeing domestic violence, who often must endure a period of trauma before joining or rejoining the workforce, could suffer even more, according to Sharon Roberson, president and CEO of YWCA Nashville & Middle Tennessee. The vast majority of women and children seeking emergency shelter at the YWCA's domestic violence shelter rely on TennCare for healthcare coverage, she said.

"I think it's unconscionable," she said. 

The panel was sponsored by The Tennessean and the Tennessee Justice Center, a non-profit law firm that assists people in getting TennCare and other public benefits. 

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Reach Anita Wadhwani at awadhwani@tennessean.com; 615-259-8092 or on Twitter @AnitaWadhwani.