A voluntary job services program for people who got health insurance coverage through Medicaid expansion in Montana has helped more than 75 percent of previously unemployed participants get jobs.
The program, called HELP-Link, was part of the 2015 state Legislature's Montana Health and Economic Livelihood Partnership, or HELP, Act. Implemented in 2016, it helped more than 96,000 Montanans get health-care coverage.
According to a report by Manatt Health and commissioned by the Montana Healthcare Foundation, 78 percent of Medicaid expansion enrollees who were unemployed at the start of their coverage and went through the HELP-Link program have gotten jobs. That's about 200 people, according to the state Department of Labor and Industry.
The report also showed that many people covered under Medicaid expansion already had jobs or are now working. Just over 81 percent live in families where at least one adult is working; 67 percent are working themselves.
Of those who aren’t working, most are sick or disabled, caring for someone who is or are in school.
Expansion covers people who make up to 138 percent of the federal poverty level, or $15,418 a year for an individual or $26,347 for a family of three.
Montana Healthcare Foundation chief executive officer Aaron Wernham said the voluntary work services program is unique to Montana and the report's findings could be useful to look at in a time when some states are transitioning to work requirements to be eligible for Medicaid coverage.
“I think this is a nationally significant finding,” Wernham said. “It is a debate in many states.”
In January the Centers for Medicare and Medicaid issued a letter that provided guidance to states on implementing a work requirement to receive Medicaid coverage, signifying a shift from the guidelines from past administrations.
As of last week, the Kaiser Family Foundation reported seven states had approved work requirements and requirements were pending in an additional four states. Warnham says his foundation’s report shows voluntary programs can be successful.
“Instead of imposing work requirements, (workforce services were) offered to every adult that receives Medicaid. The HELP-Link program has provided services now to more than 22,000 Medicaid enrollees, getting them training and employment ads, job openings. Nearly 80 percent of them who’ve gotten one-on-one services have actually found a job or a better paying job,” Warnham said.
The report also found health care industry jobs like nursing and medical assistants accounted for half of the jobs pursued by HELP-Link participants. About 72 percent of participants in the program who didn't need expensive job counseling still increased their wages, by an average of $1,680 annually in 2016.
Scott Eychner, administrator of the Workforce Services Division of the Labor Department, said one of the most meaningful stories of HELP-Link participants to him includes a woman now working in the medical field.
The Thompson Falls mother had struggled to find a job before going through the program.
“She was in a bad way, didn’t have any real hope, didn’t have any job prospects, didn’t have any skills, had a couple kids she was trying to take care of,” Eychner. After HELP-Link, she got a job in the health care industry and is on a career path.
“Things have infinitely improved for her,” Eychner said.
A report earlier this year from the Montana Healthcare Foundation found that in the time Montana has expanded Medicaid, workforce participation has increased among low-income earners. The report, conducted by the Bureau of Economic Research at the University of Montana, found that labor force participation among Montanans eligible for Medicaid expansion coverage rose 8.5 percent since expansion while it dropped 2.5 percent nationally.
That report did not draw any conclusions as to the cause of the increase here, but said the result was "consistent with the hypothesis that Medicaid expansion and Montana's HELP-Link program improved employment outcomes for Montana's Medicaid expansion beneficiaries.
“Couple (the new report) with what was in our report a month ago, where Montana was, over the period since expansion, the only U.S. state that saw an increasing rate of employment among low-income residents. We’ve not seen another state achieve that,” Warnham said.
Eychner said the program has been more successful than he could have predicted.
“Having a voluntary program, not advocating for or against work requirements … that’s what’s been given to us and it’s been great. We have had success,” Eychner said.
Eychner said his biggest concern about the national conversation on work requirements for Medicaid is the parallel being drawn to Montana’s voluntary program.
“I would hate for someone to look at this and say if you had success with the voluntary requirement, look at what you’d have with (mandates.) Those two things don’t scale. You need money and purpose behind doing those things.”
Money means the financial support to run a workforce program at a scale large enough to help the people who participate. Work requirements could create demand that overwhelms services, Eychner said.
The Labor Department received about $844,000 in fiscal year 2018 to help administer the program. Through the end of November it had spent about $360,000. The program was allocated $1.8 million from the Legislature in the 2015 session to help cover startup costs, training and serving clients.
About 22,000 people, either already employed or not, received employment services and more than 2,500 had one-on-one work counseling.
The federal government initially paid for the full cost of Medicaid expansion, but the amount it covers will taper down to 90 percent by 2020.