COLUMBUS, Ohio – State leaders in Ohio are making a push for Medicaid work requirements, but some researchers are cautioning that could turn back the clock on progress made to improve health-care access.

About 3 million Ohioans are insured through Medicaid, including more than 700,000 who were added during the 2016 expansion. According to a report by Loren Anthes, public policy fellow in the Medicaid Policy Center at the Center for Community Solutions, more than six in ten Medicaid enrollees in Ohio already work full- or part-time.

"The Legislature has a concept that a lot of the folks who are part of the Medicaid expansion are just siphoning benefits, but that couldn't be further from the truth," Anthes insisted. "In fact, most folks are on it for less than a year, and most of the expense of the program lies with the disabled and the elderly, not with the Medicaid-expansion enrollees."

The Centers for Medicare and Medicaid Services issued guidance in January asserting that work requirements can improve health and well-being, and help families gain economic stability.

Anthes counters that evidence from other safety-net programs shows that isn't the case, and said many Medicaid enrollees could lose coverage because they may not be able to meet the requirements, due to job or family commitments.

Medicaid work-requirement waivers were recently approved for Indiana and Kentucky, and have been requested by several other states. But Anthes noted there are questions about the legality of the waivers.

"In states where you've seen this move forward, there have already been lawsuits put out there," he said. "And I imagine that will be much the same here in Ohio, with a lot of this potentially tied up in courts and many folks concerned that this is a violation of the Social Security Act."

He cited economic concerns as well. Health care is the second-largest industry in Ohio, behind agriculture. He explained if too many people lose coverage, some medical facilities, particularly in rural areas, may need to close their doors.

"To suddenly remove these resources not only dis-benefits this huge area of employment and this huge area of economic impact for providers and others, it would have drastic impacts on things like the opioid epidemic, on chronic-disease management," Anthes said.

The American Medical Association and the American Academy of Pediatrics are among physicians' groups opposing work requirements, claiming they create barriers to getting health care.




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A new report analyzes Pennsylvania's existing voucher programs, that divert public funds to private schools.

This comes on the heels of Gov. Josh Shapiro's plan to create a new voucher program for K-12 students.

Diana Polson - senior policy analyst with the Keystone Research Center - said last year's Commonwealth Court decision ruled that Pennsylvania's system of funding public education is unconstitutional, therefore the state doesn't have a dollar to waste on expanding existing private-school voucher programs or creating a new one.

"The basic-education funding commission estimated the state must pay $5.1 billion over the next seven years to make sure our public schools are funded equitably and adequately," said Polson. "Meanwhile, our report finds that existing private-school voucher programs are siphoning millions from taxpayers with little to show for it."

Supporters argue that vouchers let children leave under-performing public schools and get a better education at private schools.

Polson said Pennsylvania's voucher programs have no "meaningful educational or financial accountability," so they really have no way of knowing if these programs operate as intended or are beneficial to low-income or moderate-income students.

Polson said the report reveals that the programs have grown, and just this year they will cost the state nearly $500 million.

However, these voucher programs exclude students in rural areas, because there are few if any participating private schools in these regions.

Local public schools remain the primary option for most rural families.

"We also found that private schools receiving these funds are allowed to - and do - routinely discriminate against students for reasons including disabilities, sexual orientation, religious beliefs and more," said Polson. "These programs are also exclusive. They subsidize the state's most elite and expensive private schools as well as affluent families."

Polson said the report reveals that the Independent Fiscal Office estimated that the average EITC program scholarship was $2,314, while the Opportunity Scholarship Tax Credit was slightly less at around $2,000.

The cost of attending one of the top 25 private schools in Pennsylvania is around $41,000 per year. This means these schools are still out of reach for many low- and moderate-income families.

As Nebraska's 2024 legislative session draws to a close, family caregivers and their supporters are closely watching the progress of Legislative Bill 937, the Caregiver Tax Credit Act.

The bill provides eligible family caregivers up to $2,000 in tax credits for out-of-pocket expenses or up to $3,000 if the family member receiving care has dementia or is a veteran.

Jina Ragland, state director of advocacy and outreach for AARP Nebraska, said family caregivers are filling health care gaps in the state, especially with 15 Nebraska counties currently lacking a nursing home or assisted-living facility. Ragland argued the state's family caregivers need and deserve financial support.

"We really feel they're the backbone of the U.S. care system," Ragland emphasized. "Especially here in Nebraska because they're helping parents, they're helping loved ones live independently in their homes."

Family caregivers in the U.S. spend an average of $7,000 per year in out-of-pocket expenses. Employed caregivers sometimes lose wages when they have to take time off for caregiving responsibilities. Others retire early, losing both wages and retirement income.

The bill includes an income limit of $50,000 for individuals and $100,000 for married couples. Sen. Eliot Bostar, D-Lincoln, introduced the bill on behalf of AARP Nebraska. The legislature is expected to debate the measure for the second time this week.

Joyce Beck of Grand Island knows firsthand the emotional and financial strain of being a caregiver and losing a loved one. She retired early to care for her husband, who suffered from multiple sclerosis and cancer. In addition to significant out-of-pocket expenses, her Social Security and pension payments are both lower because she retired early.

Beck said she knows some Nebraskans face bigger financial struggles as a result of their caregiving.

"If there's any financial support that we can give, that would be so beneficial," Beck contended. "Some people don't have the option of a retirement account or a pension plan, so $2,000 would be huge for them. "

Ragland stressed family caregivers are helping Nebraska taxpayers as well. When their caregiving delays or prevents expensive-nursing home placement, it contributes to lowering the state's Medicaid costs.

"An important concept for people to understand is the value of those people who are just doing what they think is right," Ragland asserted. "The time and the money and the energy that they're providing as family caregivers to offset, again, the gaps in the care services that we have in our communities."

Six states currently offer a caregiver tax credit, and there is a bipartisan bill in the U.S. Congress to enact one at the federal level.

As California faces a $38 billion budget deficit, state lawmakers have identified $17 billion in potential cuts before the Legislature begins crunching the numbers later this week.

Initial plans include shifting some funds away from job training programs but the idea is getting some pushback. Advocates of the programs said at a time when skilled worker shortages plague essential sectors, investments in job training are needed.

Lisa Countryman-Quiroz, CEO of San Francisco-based Jewish Vocational Service, a nonprofit job training agency helping to match jobseekers with employers, said current economic conditions call for investment in programs like theirs.

"This is absolutely critical given the cost of living, given rising economic inequality in the state of California, the people who really want to be able to provide for their families, people who want to be able to advance in their careers," Countryman-Quiroz outlined. "We are helping people get there."

Democrats, who hold a supermajority, agreed last week to reduce the state's projected shortfall through spending cuts, delays, deferrals and cost-shifting. The budget debate could start as soon as Thursday.

Countryman-Quiroz said while job training can have high costs, workforce investments often pay for themselves by closing opportunity gaps in employment and creating economic revenue. She cited one program, known as the High Road Training Partnership.

"We see a really positive return on investment," Countryman-Quiroz pointed out. "Every dollar that JVS specifically has received in HRTP funds has resulted in $2 in wages for the jobseekers that we work with."

Jordan Hernandez, a graduate of the High Road Training Partnership, said he has successfully accessed both education and job opportunities.

"This program has given me a lot of confidence, especially with school things," Hernandez noted. "I never thought I'd be in school, so once I got into this program, I was very nervous, but they were very welcoming. They treated me with respect, and they understood where I was coming from."


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