I have worked in the social services space for over 20 years and one thing I have learned is that a common misperception that recipients of social services do not want to work is simply not true. There are however, many barriers to work that are often overlooked. As we look at how states can effectively implement positive work programs, which help people become self-sufficient. We must change another common misperception, that the intention to initiate work requirements is for the sole purpose of removing people from social service programs for non-compliance.
The federal government allows states to develop Section 1115 Waiver demonstration projects to experiment and design programs where states are thinking outside the box to better serve Medicaid populations within their unique state circumstances. I have often been accused of wearing my rose-colored glasses, therefore I assume positive results will be achieved by 1115 waiver demonstration work programs when implemented altruistically. I believe we can make amazing progress with our Medicaid population through the use of the Section 1115 Waiver demonstration projects. Just as a member may be faced with many barriers to success, often so are the programs designed to serve them. The Section 1115 Waiver demonstration allows states to put on their rose-colored glasses and ask how things can be different. In addition, where can they see results when member barriers are methodically removed. States are currently seeing success when members are actively engaged in their health decisions, have personal responsibility, and engagement in personal healthcare plans through:
- Selection from a variety of different health plans
- Options to financially participate in their health coverage to receive enhanced benefits
- Opportunities to receive incentives for engaging in healthy behaviors
- Availability of tobacco cessation programs
- Selection of medical providers who can best serve their needs
So now that we have people engaged in their healthcare and they have some level of control, and are healthier, what’s next? For many members, barriers to adequate employment is their next hurdle to overcome.
Let’s keep those rose-colored glasses on and believe that people want to work and be healthy. We have this incredible opportunity called the Section 1115 Waiver Demonstrations to make that happen. This does however, require all of us to roll up our sleeves and engage entire communities at many levels in order to see success. By engaging members in volunteer community activities and partnering with large organizations, who offer time away from work to also participate in these activities, we can place people with barriers in environments where they are working alongside other people who either had no barriers or have successfully overcome them. If ten out of 100 people have a positive experience in the community engagement activities and make connections to people who can either assist in furthering their skill sets or better yet, assist them in more engagement or job activities, I would consider that a success. One may then think, what about the other 90. We do not forget about them and we continue to work with them through health plan engagement. We identify what barriers are preventing their success. We intentionally focus on what is not working and break down that issue. As you can imagine it is not a systematic fix for everyone. Even wearing my rose-colored glasses, I know that it is not easy, but we have to keep the goal in mind.
Every successful engagement leading to a new opportunity for a person to learn and grow is a step in the right direction. We need to look at these waivers as opportunities to create paths to success. As far as Return on Investment, real success stories are priceless. Situations that may not be as successful provide additional opportunities to learn from the successes and improve processes and focus on what works. Skeptics will still insist it cannot work and will cost a lot of money and kick people off. Rose-colored glass wearers will insist, it will work with the combination of:
- Marketing it to help people, not hurt people
- Active large community engagement
- Dedication to positive experiences on the part of the health plans who are working with people every day
- Government officials who serve the state residents with their best interest in mind.
Won’t you join me in wearing rose colored glasses?