ARI SHAPIRO, HOST:
Republican leaders want states to have more control over Medicaid. That's the health-insurance program for poor and disabled people paid for by states and the federal government. When the Trump administration takes office, GOP leaders may get their wish. One step could be the kinds of experiments that Republican-controlled states like Montana have tried. Montana Public Radio's Eric Whitney explains.
ERIC WHITNEY, BYLINE: State Senator Ed Buttrey is a no-nonsense businessman from Great Falls in central Montana. Like a lot of Republicans, he's not a fan of the Affordable Care Act and its expansion of Medicaid.
ED BUTTREY: We didn't want to implement a plan that was another entitlement that just had a bunch of people signing up to get free or cheap or subsidized health care. We wanted a plan that said, we're going to get you on. We're going to get you healthy. We're going to identify your barriers to employment or better employment. And then we're going to move you off the plan.
WHITNEY: So Buttrey wrote a Medicaid-expansion bill for Montana that linked health coverage to a job-training program. He wanted everyone getting benefits to have to meet with a labor specialist who'd help them figure out how to get a job or a better-paying job.
BUTTREY: Make them healthier. Get them off social programs. Get them off dependence on government. Get them into higher-wage jobs that have a future that possibly pay benefits. That's a great benefit for the state.
WHITNEY: But federal officials said states can't make participation in a work program mandatory for Medicaid recipients. So Montana made it voluntary. And Medicaid expansion passed here last April. How's the job training working?
RUTH MCCAFFERTY: I think it's a success story.
WHITNEY: Ruth McCafferty is a 53-year-old single mom with three kids at home who lost her job last spring.
MCCAFFERTY: I'm the poster child (laughter).
WHITNEY: She had no idea there was a new job-training program available when she signed up for Medicaid. She was just focused on finding a way to afford the drugs she needs to control her diabetes and asthma.
MCCAFFERTY: One inhaler that I do is $647. It's, like, a thousand dollars a month. My plan was not to get them - only, like, a couple of them that were affordable - like, $60. And then the rest of them - I was just like, I guess I'll just be called Wheezy from now on (laughter).
WHITNEY: McCafferty got Medicaid. And she got free online training to become a mortgage broker. The state even paid for her 400-mile round trip to Helena to take the certification exam. And now they're paying part of her salary at a local business as part of an apprenticeship to make her easier to hire.
MCCAFFERTY: It's awesome (laughter).
WHITNEY: Of the 53,000 Montanans who've signed up for expanded Medicaid, only about 3,000 have signed up for help getting a job. That's in part because states aren't allowed to use Medicaid money for stuff like this. To set it up here, Buttrey had to cobble together funding from other jobs programs and squeeze a million dollars out of a reluctant state legislature.
Giving states the flexibility to tie their Medicaid programs to work requirements is an idea that's likely to be popular with the new Congress and Trump administration. But health-policy researchers like Joan Alker, who runs the Center for Children and Families at Georgetown University, warned that it could backfire.
JOAN ALKER: I think it's great and well worth doing to link people who might not be aware of existing job-training programs or other kinds of work supports that can help them work. What I think is problematic is when this becomes a stick and not a support.
WHITNEY: Alker says a lot of people on Medicaid already have jobs, which leaves them little time for new training. She says if people fail to meet a work requirement and then lose health benefits as a result, they'll likely just get sicker and become less able to work. For NPR News, I'm Eric Whitney in Missoula, Mont.
SHAPIRO: This story is part of a reporting partnership with NPR, Montana Public Radio and Kaiser Health News.
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