Will work for Medicaid?

If federal officials concur, Pennsylvania could become the first state in the country to require many people receiving Medicaid benefits to look for work.

So how many people now find work through the state's JobGateway system, where people on welfare must search for jobs?

State officials do not know. "We are working on that now," said Sara Goulet, spokeswoman for the Department of Labor and Industry, which runs the site.

The issue is key, since Gov. Corbett's novel plan to expand Medicaid would require tens of thousands of people eligible for the expansion, as well as some now on Medicaid, to do monthly job searches.

Is the state ready?

"At least part of the burden on folks advocating this is to at least count and see if it makes sense or see if it's just a barrier that dissuades people from getting what they need," said lawyer Richard Weishaupt of Community Legal Services.

Work-search requirements do help push people into jobs and cut dependency on public services, said Lynn Karoly, a Philadelphia-area senior economist with the Rand Corp.

But "the wages they can earn are more or less one-for-one what they lose in benefits," she said.

Many Medicaid-eligible people have other problems in finding work, she said, such as long-term unemployment and little education and work experience.

Corbett's proposal exempts the severely disabled, pregnant women, students, and institutionalized people from work-search requirements, although not the homeless.

For them, "it's hard to imagine they're going to be able to take the time, when you have no idea where you're going to sleep tonight, to go find a computer and apply for jobs," Weishaupt said.

In some counties, only "two or three jobs" may be appropriate to a person's credentials on the JobGateway system, Weishaupt said. Should people lie to meet the standards of other jobs or waste resources on jobs they can't get, just to meet the rules? he asked.

To become eligible initially, recipients would have to complete 12 "work search activities" a month. This could make it harder for people to get on Medicaid's rolls. When the temporary cash assistance program implemented a similar requirement in 2012, the state's rejection rate jumped to 80 percent.

There's also the potential administrative burden to the state, which says it will audit Medicaid recipients every six months. "What are the costs of administering this kind of requirement and the verification systems that go along with it?" Karoly asked, "and how do these costs weigh against any savings?"

Corbett has not said how much his plan to privatize Medicaid will cost. He would use Medicaid funds to pay the premiums of commercial plans. The federal government must approve the changes and it requires that a novel plan not cost more than traditional expansions, which Pennsylvania's neighbors are doing.

Work search would require technology updates to enforce the policy, said Kait Gillis, Department of Public Welfare spokeswoman. It would also need more DPW staff but "not as much as" a traditional expansion."

Both the federal law and Corbett's alternative would expand Medicaid to people earning up to 138 percent of the poverty level (about $16,000 for an individual). Pennsylvania already devotes 27 percent of its General Fund to Medicaid. Expanding it would be "financially crippling," Gillis said, even though the federal government would pay all of the cost through 2016, falling to 90 percent by 2020 and after.

Weishaupt called it "telling" that no other state has proposed a job search requirement, and Congress has never demanded it.

"Nobody's against helping people find jobs," he said. "It's just that the idea that people will be punished and will be made to go without health insurance if they mess up is unfair."

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