New Medicaid Eligibility Requirements Hit Close to Home

Over the past nearly 40 years I’ve spent a lot of time trying to understand how various local, state or federal policy choices might affect various groups of people – children, families, women, people with disabilities, etc. Sometimes I focus on how a decision might affect an individual, but most of the time I’m wrapped up in trying to understand what data tells us about how a proposal might or might not work. Recently though, I learned that pending state policy change could likely result in a lot of my neighbors losing their health care coverage.

Recently I reviewed data prepared by the Cuyahoga County Department of Job and Family Services (JFS). This is the county agency that administers state programs like Medicaid, the Supplemental Nutrition Assistance Program, the Temporary Assistance for Needy Families program and others. Their caseworkers are on the front line of efforts to reduce poverty locally.

Cuyahoga County JFS produced a map showing where the largest number of county residents lived who are most at risk of losing their Medicaid coverage due to proposed state eligibility changes. The Medicaid eligibility changes requested by the State of Ohio would limit Medicaid coverage for approximately 92,000 Cuyahoga County residents. If eligibility changes go into effect only those who work at least 20 hours a week or who fit into various exemption categories would qualify for Medicaid. Cuyahoga County identified and mapped the 7,000 county residents who either aren’t working, or aren’t working enough hours, and also those who don’t have an obvious exemption from the new requirements.

The neighborhood with the most people at risk of losing their Medicaid coverage is my own Detroit Shoreway neighborhood

The neighborhood most at risk, according to the map, was my own Detroit Shoreway neighborhood, the place I have called home for the past 26 years. According to county data, nearly 500 of my neighbors are at high risk of losing their Medicaid eligibility. While I have seen a lot of positive physical and economic transformations in the neighborhood over the past 26 years, not everyone has shared equally in this renewed prosperity. When my Center for Community Solutions colleagues assembled data for every Cleveland neighborhood last year they found Detroit Shoreway’s children, families and the elderly were more likely to live below the poverty line than residents of the city as a whole. Median household income is also lower, at only $23,000 a year, and half of renters in my neighborhood live in unaffordable housing (a problem that has likely gotten worse). It also has one of the largest Hispanic populations in the city, and research shows that language barriers, discrimination, and now concerns over immigration issues prevent these individuals from obtaining needed help and benefits. So, in some ways it’s not surprising that Detroit Shoreway finds itself atop the list.

Fortunately there are new and creative neighborhood-based efforts underway to help connect Detroit Shoreway residents to local jobs and opportunities. The Hire Local Campaign represents a partnership between the Detroit Shoreway Community Development Corporation and the El Barrio Workforce Development Center that is operated by the Centers for Families and Children. When the program was announced in April, 2017 organizers said they had identified 50 neighborhood jobs that would need to be filled in the next 18 months. Twenty-two local businesses pledged to hire local residents – for jobs that are mostly either in food service, health care or customer service. A benefit of the program is that because the jobs are located in the neighborhood, transportation is largely eliminated as a barrier to hiring and employee retention.

The State of Ohio isn’t offering any additional aid to neighborhoods like Detroit Shoreway that could be hit hard by new Medicaid eligibility requirements

Ohio’s own data shows that most Medicaid recipients who can work are already working, but some aren’t able to, have barriers to employment, or are using Medicaid benefits to improve their health so they can work. It’s this group that will require a much larger effort than the Hire Local initiative has been able to accomplish to date, and will require the investment of additional public resources. A majority of the Center’s workforce clients are either African-American and or Hispanic, have incomes below 200% of the poverty level, and are under the age of 44. They estimate the cost of serving these clients and helping them get employed is between $5,000 and $9,000 a year depending on specialized training and certifications completed. Unfortunately, Ohio isn’t offering any additional aid to hard hit neighborhoods like Detroit Shoreway. In fact, Cuyahoga County estimates that just administering the new requirements and managing the accompanying red tape will cost the county upwards of $11 million a year. Potentially diverting funds away from services like the Centers provide that could actually help individuals find, and keep, employment.

Medicaid eligibility cuts can put pressure on health care providers in my neighborhood like Neighborhood Family Practice

The potential loss of Medicaid coverage could also harm health care providers (major employers) in the neighborhood who could potentially see a much larger number of uninsured neighborhood residents seeking care. Neighborhood Family Practice, a federally qualified health center, is one of the largest health providers located in the neighborhood. The health center is located in the heart of the Detroit-Shoreway neighborhood, and its current payer mix is more than 65% Medicaid. Neighborhood Family Practice will almost certainly feel the impact if 500 of their neighbors lose their Medicaid insurance and end up uninsured.

Tip O’Neil, the legendary former Speaker of the U.S. House of Representatives, is famous for saying that “all politics are local,” and that’s certainly the case in this instance. If the federal government approves Ohio’s proposed changes in Medicaid eligibility, and if the changes survive expected court challenges, the impact will almost certainly be felt in my Cleveland neighborhood.

Table 1

10 Top Cleveland Area Neighborhoods and Communities with Most at Risk of Losing Coverage

 Neighborhood/CommunityZip Code# at High Risk of Losing Coverage% African- American Population% White Population
1Detroit Shoreway/Edgewater4410248726%61%
2Broadway-Slavic Village4410547673%23%
3Brooklyn Center4410935015%70%
6Shaker Heights4412027070%23%
7East Cleveland4411226490%6%
8Collingwood Nottingham4411026283%14%
9St. Clair Superior4410324679%14%
10Kinsman 4410424096%3%

Source: Potential Medicaid Work Required Without Known Exemption, Cuyahoga County Department of Job and Family Services, May 30, 2018