Trump Administration Moves to Allow States to Impose Medicaid Work Requirements

2018-01-11 - Centers for Medicare & Medicaid Services - CMS.gov

The Trump administration will allow states for the first time to impose work requirements on Medicaid recipients.

Ten states - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin - have already filed applications with CMS to add work requirements to their Medicaid programs. Health officials could approve the first waiver - probably for Kentucky - as soon as Friday, according to two people with knowledge of the process. Most who are not report reasons such as illness, caring for a family member or attending college. Kaiser also said a work requirement is popular.

Such regulations are already in place for most recipients of Supplemental Nutrition Assistance Program, commonly known as food stamps. Many of these recipients are individuals who are employed but whose jobs do not provide health insurance. It's unclear how numerous remaining able-bodied recipients would fall under the new requirements.

CMS Administrator Seema Verma said on Twitter that the new efforts will "improve Medicaid enrollee health outcomes by incentivizing community engagement".

"California will not impose work requirements on Medi-Cal beneficiaries", said Jennifer Kent, director of the Department of Health Care Services, which administers Med-Cal. This disagreement with expansion lies at the heart of the decision to allow states to make Medicaid changes that the states themselves admit will reduce coverage.

In an address to Medicaid directors in November, Verma said that with Medicaid being an open-ended entitlement, the program and spending have grown.

An advocacy group in ME vowed to fight the waiver, arguing that it's illegal and that the current Medicaid program supports work by giving people access to health care, making them more likely to stay well enough to be employed.

The critics are prepared to pounce on that rationale.

Lead author Renuka Tipirneni, M.D., M.Sc., a U-M assistant professor of internal medicine, is available to discuss the results and how they might inform the national and state-level discussion about requirements such as those laid out by CMS.

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The new policy would not apply to people who qualify for the program because of a disability, the memo said. "It's not a good idea, and it's illegal". It's a little like saying that rain causes clouds. He dismissed the agency's justification that unemployment makes people less healthy.

The shift under Trump could draw legal challenges from health care, rights or seniors' groups.

Medicaid is a government program for people of all ages whose income and resources are insufficient to pay for health care.

"This is about helping people rise out of poverty", Verma said Thursday in a conference call with reporters. It is more common for Medicaid enrollees to hold jobs if they live in states that expanded Medicaid under Obamacare.

The most recent federal figures show that Medicaid enrolls more than 68 million low-income Americans, including children, pregnant women, people with disabilities and the elderly. Many Republican-governed states declined to take part in the expansion. The demonstration projects will be done by Section 1115 Medicaid waivers as under current law, states can not impose a work requirement as a condition of Medicaid eligibility. According to government statistics, 60 percent of non-disabled, working-age adults having a job, while almost 80 percent live with families that have at least one member in the labor force. "Each state is different", the letter says, and such activities "include, but are not limited to, community service, caregiving, education, job training, and substance use disorder treatment". She has long pushed for new requirements for Medicaid patients. For low-wage workers, such as waitresses with fluctuating wages, "it boggles my mind", Stewart said.

The Trump administration is paving the way for one of the biggest policy changes to USA health care in decades.

Verma, and proponents of the requirements view it differently. If you're "able-bodied", the logic goes, you shouldn't be able to access a free health care program if you don't have a job and help pay into the public system that subsidizes such coverage.

The new regulations' supporters argue that it's a common sense idea.

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