Week in Washington: Work Requirements Experience

September 6, 2018: Work Requirements Experience

Work requirements for Medicaid beneficiaries has been a prominent topic among recent Medicaid waivers. Over a dozen states are in various stages of attempting to implement work requirements. The first state to implement work requirements was Arkansas. This week, beneficiaries not meeting work requirements will lose eligibility (the program started in June and three months of non-compliance are needed to lose coverage). A few data points on the initial effects.

  • 46,025 Arkansas beneficiaries were initially subject to the work requirement.
  • 30,288 were automatically exempted (based on wage or disability data).
  • As of Thursday 4,575 failed to meet the work requirements and will lose coverage for the remainder of the year.
  • It should be noted that this number will increase as the year goes on. For example, nearly 13,000 did not meet the requirement in the first month.

ACA on Trial

The case of Texas v. the United States had its oral hearing on Wednesday. Texas and a coalition of GOP attorney generals contend that the effective repeal of the mandate means that the entire ACA should be rendered unconstitutional and invalidated. While Judge O’Conner did not make any rulings, he did have a series of pointed questions against those arguing in favor of the ACA and probed about the potential impact of an immediate injunction. Whatever the judge rules will be appealed, but the judge’s questions did raise fears of a ruling against the ACA.

Mergers/Medicare Part D

Politico reported that the Department of Justice could soon approve Cigna-Express Scripts and CVS-Aetna mergers. The Wall Street Journal is reporting that CVS-Aetna will likely need to shed Medicare Part D businesses.

New Research on Bundled Payments

One of the ACA initiatives on bending the cost curve surrounded bundled payments (paying hospitals a single amount for a procedure rather than for every service). The concern about bundled payments is that hospitals would increase the number of procedures and select less risky patients. New research out this week finds that neither of these are occurring. The researchers found negligible changes in number of procedures and no selection against minorities or poorer patients. They did find that hospitals that use bundled payments did accumulate more market share. If the findings continue to be proven true it would lend credence to bundled payments as an important avenue to control costs.