Szdfan wrote: ↑Sun Oct 05, 2025 1:38 pm
Ironically, it’s the people least equipped to handle these changes, like large, rural, self-employed Anabaptist families that are exactly the ones most likely to lose coverage with Medicaid cuts and work requirements.
1) A lot of self-employed farming and ranching families don’t have verifiable wage documentation (like W-2s or pay stubs) to prove they’re working the required twenty hours. When people work for themselves, they rarely pay themselves a formal, documented wage. (I’m chaperoning my school’s FFA chapter to their fall conference — I just confirmed this with the group sponsor whose family owns a ranch).
Have you ever actually applied for Medicaid when self employed?
You have to fill out quite a bit of paperwork to verify/document income - if you don't have a reasonable tax return. If you do, you can just turn in last year's tax return. That's required already and has nothing to do with 20 hours. As far as confirming the 20 hour work requirement... the law has a provision that any self employed person is assumed to be meeting the 20 hour requirement. (I don't know how they will handle "negative income" or "zero income" self employed people. I was negative income one year without a tax return filed for the prior year yet which was even more paperwork to fill out, but it wasn't impossible. The benefits you get when in negative-income are very generous.)
When people work for themselves, they rarely pay themselves a formal, documented wage.
I'm not sure where you get ideas like this. When people work for themselves, they often get a 1099, which is formal documentation. Otherwise, they file income tax returns, which are another form of documentation of what they pay themselves.
It's true that if someone plans to cheat on their taxes and not document or report accurately what they pay themselves, it will be more challenging to qualify for Medicaid. Medicaid offices generally are stricter than the IRS when it comes to documenting income. But that doesn't mean it's impossible. For example, in my state, if you don't file tax returns and aren't sure what your business expenses are, you can simply report your gross income (from 1099s or a bank statement or PayPal account, etc showing deposits) and you are allowed to compute 50% of that as expenses. This is a very common situation for people like someone who drives for DoorDash.
2) Farming is also highly seasonal work. With more frequent eligibility checks, farm families may cycle in and out of Medicaid when their seasonal income spikes, even though their annual income remains too low to afford private insurance.
No, they won't, because Medicaid is based on annual income, including seasonal income. If your income is variable, you document that and turn it in. For self employed people including farmers, a tax return is enough to show annual income. You do have a legal obligation to report if you think you're going to make more money this year. For many people that's just not a problem!
There are not "more frequent eligibility checks". You requalify once per year, and then halfway through the year do a redetermination. On the redetermination, you simply sign something saying "nothing's changed", or if it has changed, you say what the change is.
Food stamps already had a 20 hour per week work requirement so all the infrastructure already existed for this. People really want their food stamps and are willing to do the extra paperwork needed to qualify. It's not burdensome or onerous.
3) Conservative Anabaptists often rely on rural medical providers that depend heavily on Medicaid reimbursements. With these cuts, many of those providers won’t survive. I’ve already heard of three clinics closing in the Shenandoah Valley this September and my local hospital has been cutting services. There are questions over whether it will close. That not only means lost local jobs but also that people here would have to travel an hour or more for medical care.
Szdfan, you're basically full of nonsense - sorry to put it that way, but I'm not sure how else to say it. Most conservative Anabaptists don't use Medicaid or state aid at all. I am in one of the very few conferences that does do so.
Holmes County (the largest Anabaptist concentration there is) is very well served by many different providers, some of which are cash pay only (and work with mutual aid plans), and some of which take Medicaid and insurance. There really isn't much of a problem at all with "rural" medical providers in Ohio where Anabaptists live; if anything, it's one of the best places in the country due to the diverse range of options. I don't think I could honestly get better medical care anywhere else.
In PA, a group of Amish are busy building their own health center which will have their own providers. That's another option conservative Anabaptists can do, particularly ones who don't want to participate in state aid plans.