Trump administration opens door to allowing Medicaid work requirements

Posted January 12, 2018

Echoing Bruenig in a tweet on Wednesday, Roosevelt Institute fellow Michael Linden concluded, "There is perhaps no better example of the moral rot at the core of the Republican Party than imposing so-called "work requirements" on sick Medicaid recipients just weeks after passing a massive tax cut for rich heirs who literally did no work at all to inherit their wealth".

"This is about helping those individuals rise out of poverty", said Seema Verma, administrator for the Centers for Medicare and Medicaid Services. It said states should exempt certain populations, such as people with disabilities, and should consider issues like substance misuse and regionally high unemployment rates.

Medicaid is a federal-state collaboration covering more than 70 million people, or about 1 in 5 Americans, making it the largest government health insurance program.

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

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The move is expected to impact millions of Americans who rely on the state-federal program to help get health coverage.

Families USA said the decision represents "a radical shift in CMS policy that violates federal law and is part of an ideological agenda that is hostile to government assistance with health coverage". About 70 percent of Americans say they support states imposing a work requirement on non-disabled adults, according to a Kaiser Family Foundation poll past year. These able-bodied men and women are the ones who will be required to find work in order to keep their Medicaid benefits. They include Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

Advocates for low-income people said work has never been a requirement for Medicaid, a program originally intended as a health program for the poor and disabled.

Adding work requirements for Medicaid may not drastically affect enrollment totals, since 78 percent of Medicaid beneficiaries are working, according to an analysis from the Kaiser Family Foundation (KFF). 36% said they were ill or disabled, 9% said they were retired, and 30% said they were taking care of family or their home.

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The range of community engagement requirements can be quite broad, according to the CMS guidelines sent to states on Thursday. Most who are not report reasons such as illness, caring for a family member or attending college. Many of them have jobs that don't provide health insurance. This addition to the Medicaid program was adopted by thirty-one states, as well as the District of Columbia. "People who participate in activities that increase their education and training are more likely to find sustainable employment, have higher earnings, a better quality of life, and, studies have shown, improved health outcomes".

The N.C. waiver request proposes a hybrid public- and private-sector reform solution that eventually would combine physical and behavioral health into a whole-body care platform. They fear many recipients will be unable to meet the mandate and be left uninsured.

DHHS had set a goal of beginning in March the bid process for the statewide and provider-led entities.

"This is creating an impediment to people who might've lost their job and in fact need help getting work, not an extra requirement that keeps them from getting the needed medical care that keeps them healthy", Wagner says.

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"I don't know that that one change would make any sort of fundamental change", House Appropriations Chairman Nelson Dollar, R-Wake, said. Advocates for low-income people say they expect Kentucky's waiver to be approved shortly.