Trump administration opens door to let states impose Medicaid work requirements


After the Trump administration's announcement Thursday that it would allow states to impose work requirements on "able-bodied" Medicaid recipients, some Pennsylvania lawmakers are taking another look at trying to bring those requirements to the Keystone State.

"Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today's announcement is a step in that direction", said Seema Verma, the administrator of the federal Centers for Medicare and Medicaid Services.

Cooper's administration hasn't asked for permission to add work requirements to the state's existing Medicaid health insurance program, which covers more than 2 million people. Some states received federal waivers to test new ideas on how to administer the program.

The Centers for Medicare and Medicaid Services issued guidance to support state efforts in requiring work or community involvement in demonstration projects such as skills training, education, job search, volunteering and caregiving.

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.

Portland Press Herald via Getty Images FILEPeople stand in the reception area of a health care provider in Maine Jan. 20 2016
Portland Press Herald via Getty Images FILEPeople stand in the reception area of a health care provider in Maine Jan. 20 2016

In those states that receive a waiver for the work requirements, those now working will be required to provide documentation that they are working, and those who are not will be required to prove that they should be exempted. Medicaid is pretty different from even other government health care programs; its beneficiaries are the poorest people in America, kids, and people with disabilities-a coalition of Americans who often have the most hard health care needs in the country compared with the employer-sponsored private health market.

Homeless people, former foster children and American Indians are among individuals who would be exempt from Arizona's proposed Medicaid work requirements, the state's application says.

But the new policy is exactly what some Republican governors were seeking.

The Trump administration on Wednesday sent a letter to state Medicaid directors announcing a policy to authorize work requirements for states with what are known as "Medicaid 1115 waivers".

Kentucky, where the uninsured rate for low-income adults plummeted under the Medicaid expansion (from almost 40% in 2013 to 7% at the end of 2016), estimates its proposed changes will cut enrollment by 15% in five years.

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Federal officials said Thursday that it would be a good sign if people left Medicaid for private coverage offered by employers. Requiring individuals to meet work requirements threatens this coverage and forces many to risk their health or family's well-being by having to decide between working or going without health insurance and needed medical care.

More than 70 million Americans are enrolled in Medicaid, and the federal government spent more than $350 billion on the program in the last fiscal year, the Congressional Budget Office says.

But Democrats and many advocates are pushing back on the guidance, arguing people will lose coverage if they don't meet the requirements or the requirements will lead some not to apply because the process may become too cumbersome. Instead, his administration has sought to weaken the program through executive orders and administrative rules. The Centers for Medicare & Medicaid Services administrator, Seema Verma, has said the ACA's Medicaid expansion didn't "make sense", and past year the administration and the Republican Congress failed in multiple tries to repeal it outright.

"There's absolutely nothing that requires the exemption of people with addiction", Rosenbaum said. They will be exempt from the new requirements.

But CMS's Verma would have us believe that this new policy will actually improve people's health.

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It's far more likely that Medicaid work requirements will backfire, at least in terms of improving beneficiaries' living standards.

The CMS guidance gives states a great deal of flexibility to define their own exceptions to a work requirement, as well as what counts toward work.

"Medicaid needs to be more flexible so that states can best address the needs of this population", she said in a statement.

States must also fully comply with federal disability and civil rights laws and ensure that all individuals with disabilities have the necessary protections to ensure that they are not inappropriately denied coverage.

"As an example in the TANF program, the cash assistance program, there is authorization to include work limits and work requirements, and there is no such requirement in the Medicaid law", said Berg.

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