MEDICAID WORK REQUIREMENT. THE PUBLIC HEALTH NURSES WORK ENVIRONMENT, A CHALLENGE IN LEADERSHIP: The public health nurse is working in an agency that currently has 4 of its 8 nursing positions open.  There have been 3 nursing directors in the position over the last year. The work environment has not supported shared governance and independent decision-making. It is not unusual to hear insensitive comments or stereotypical statements.  There is no nursing staff diversity.  The population served by this clinic is a 5-mile radius in one of the poorest areas of Any City, Some State with a population of mixed minorities, low-income, single-parent homes, high unemployment, and poor health status and outcomes. Children attend a neighborhood school that is one of the poorer schools in the district and have even experienced lack of heat during the early part of the winter. When discussing the issues with her peers, her friends laughed at her decision to stay and recommended she leave the job immediately. The nurse has been offered the position as Director of Nursing under a new Health Care Administrator who is under a directive to correct the issues and improve the quality of care for the clients served in this community. Respond to the following questions from the perspective of a new Director hiring and employing a full nursing staff to support this agency.

Explain the workforce ecosystem model.

Using components of the model as the guiding activities in your plan, identify changes or actions that will be addressed in each component to alter this work environment as you move to full nurse staffing.

What key ethical issues identified in the ANA Code of Ethics must be addressed as a part of your plan?

Identify two types of training you would include in your orientation program for all staff. You may simply list and identify why you would include this component.


The Affordable Care Act (ACA) expanded Medicaid coverage assisting vulnerable groups, especially low-income persons. Nonetheless, the changes in the policy give a concept that work requirement is a condition of eligibility. The enactment and implementation of the policy will affect a significant number of individuals who benefited from the coverage.  According to the proposed policy, some clients will be exempted from the work requirement for receiving health benefits. Some of the clients are people with disabilities who are enrolled in the supplemental security income (SSI). Further, pregnant women and older people above 65 years will not be required to work for them to receive the ACA benefits (Tipirneni, Goold & Ayanian, 2018). More so, individuals who have an acute medical condition that prevents them from working will benefit from health coverage. Ultimately, this makes a small portion of the clients who will be exempted from the work requirement for eligibility.

Reasons why the Concept Could be Problematic for vulnerable Groups

First, a significant portion of people with disabilities will be dropped from the health coverage scheme. In Michigan, most of the people in the disabled group do not benefit from the supplemental security income. Therefore, the majority of them will not have access to affordable healthcare, despite their conditions that limit them from working. Moreover, they are more likely to fall under the poverty line, given that they will not be in a position to afford basic needs as well as health care. As a result, a health care crisis may develop in the state, given that a significant number of those that require special treatments might not have access. More so, people who have psychological and mental health issues will not benefit from Medicaid coverage. This is because the policy does not exempt them from the work eligibility.

Additionally, hospitals and health facilities are likely to record a high number of emergencies and admit patients in critical conditions (Schubel & Hayes, 2018). Such will be contributed by the fact that people who live with certain conditions will not go for routine checkups. In turn, individuals’ healthcare will deteriorate, putting their lives in danger. In cases where patients make it to hospitals while in critical conditions, they might not receive quality services due to their inability to settle bills. In the context of the health care facilities, their resources will be stretched while trying to manage and treat patients in critical conditions. As a result, the general quality of healthcare services in the state of Michigan will reduce tremendously. Ultimately, implementing the policy will have more adverse impacts on the disabled and people with special needs.

Implementation of the policy will also be problematic to the older persons in society who are also identified as being vulnerable. This category includes people who are between fifty years and 65 years. The particular group is not considered as part of those who should be exempted to benefit from the Medicaid coverage. In the United States, Schubel & Hayes (2018) report that it is difficult for people in the 50-65 age group to find jobs. Such is attributed to the perception that they have a lower productivity, and their labor could be expensive based on their experience. In turn, if the policy is implemented, it will mean that people in this age group who are not employed will be dropped from the coverage. Given their age, they are at risk of suffering from various medical conditions as their immune is decreased.

In the context of employment, the low-income groups will be significantly affected by the implementation of the policies. The expanded Medicaid coverage was beneficial to the individuals as they could get different jobs that paid low wages. With an increase in employment opportunities, the group benefited from both jobs and healthcare coverage. Implementing this policy will reduce employment opportunities as employers are obligated to employ people with a medical cover. More so, people who work part-time jobs but do not meet the number of hours required in the new policy are more likely to lose their jobs. Such will increase the unemployment percentage, and individuals are likely to fall into poverty levels. Indeed, the policies do not benefit people in the low-income group. Most of them are likely to lose both their jobs and medical covers.

Approaches to manage the Challenge of Cost for Low-income Clients

One of the approaches that can be used to reduce the cost for low-income clients could be through partial funding rather than a total loss of the coverage. In this approach, the client will only be required to contribute an amount that they are capable of, while the government supports with the rest. Further, employers who offer health insurance should be provided with tax credits. In turn, it would encourage them to hire more employees, creating more job opportunities for low-income clients. Rather than imposing the work requirement eligibility to all individuals, the policy should impose higher coverage requirements on large employers. In turn, they would contribute more to health insurance, supporting those from the low-income group who do not have stable jobs. Ultimately, solutions have to be implemented to prevent a significant portion of individuals from falling under the poverty line.MEDICAID WORK REQUIREMENT


The Honorable (Name of Representative)



Dear Representative (Name):

Fixing the Medicaid coverage crisis is not a political issue but a people issue that is related to costs. Recently, the state of Michigan has shown concern and political courage in introducing employment status as an eligibility criterion for Medicaid coverage. As a professional nurse, I witness the results of our health system every day. As such, I would like to define and share my position on this requirement. Indeed, the introduction of the work requirement is viewed as a way of reducing the burden on health care coverage, especially for adults who are eligible to work. Nonetheless, this idea hinders the challenges that will be faced by low-income clients and vulnerable groups in the state of Michigan.MEDICAID WORK REQUIREMENT

The work requirements of 80 hours each month would lead to many working people to lose their coverage. Further, the vulnerable groups of people living with a physical disability or mental health issues but are not exempted from the requirement will be negatively affected. As such, emergency and critical cases will increase as the uninsured will continue to seek services from hospitals. In turn, the rate of uncompensated medical care will increase as the majority of low-income clients will not afford it. The Michigan state fiscal agency estimates that implementing the new requirements will incur new administrative costs of between $20 and $ 30 million per year (Schubel & Hayes, 2018). This is an indication that the administrative aspect of the policy will further affect resources. Ultimately, such costs can be directed towards work support, like job training for low-income clients. At the moment, it would be best for the state to find other solutions to health coverage as compared to implementing the proposed policy.MEDICAID WORK REQUIREMENT


Student’s Name.


Schubel, J., & Hayes, K. (2018). Michigan’s Waiver Proposal Would Undermine Its Successful Medicaid Expansion. Tipirneni, R., Goold, S., & Ayanian, J. (2018). Employment Status and Health Characteristics of Adults with Expanded Medicaid Coverage in Michigan. JAMA Internal Medicine178(4), 564. doi: 10.1001/jamainternmed.2017.7055MEDICAID WORK REQUIREMENT

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