Trump administration to let states adopt Medicaid work requirements

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It is unclear how many Medicaid recipients who are actively seeking work may lose their insurance in the process if their state should choose to enact the new guidelines.

A University of MI team recently published data in JAMA Internal Medicine from detailed survey of more than 4,000 MI residents enrolled in the state's expanded Medicaid program.

The Trump administration announced Thursday that it will open the door for states to impose work requirements for Medicaid recipients, in a major shift that could affect millions of low-income people receiving benefits. "We see people moving off of Medicaid as a good outcome", she said.

Seema Verma, head of the Centers for Medicare and Medicaid Services, said work and community involvement can make a positive difference in people's lives and in their health. 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.

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Millions who rely on Medicaid, America's biggest public health insurance program, could be required to have a job if they want to hold on to their coverage in the future.

Such regulations are already in place for most recipients of Supplemental Nutrition Assistance Program, commonly known as food stamps. The program, funded jointly by the federal government and states, provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities.

Verma has recused herself from ruling on those two states' requests but has imported the ideas behind them into the new federal policy.

"This new guidance paves the way for states to demonstrate how their ideas will improve the health of Medicaid beneficiaries, as well as potentially improve their economic well-being", said Brian Neale, CMS Deputy Administrator and Director for the Center for Medicaid and CHIP Services.

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A study from the nonpartisan Kaiser Family Foundation found that a surprising number of working-age adults on Medicaid are already employed.

"This gives us a pathway to start approving waivers", Verma said on a call with reporters. That exemption also covers people undergoing treatment for substance abuse problems. Most who are not working report reasons such as illness, caring for a family member or going to school. These modifications may include counting time spent in medical treatment toward an individual's community engagement requirements or exempting individuals participating in intensive inpatient or outpatient medical treatment, as well as supporting other state efforts. In fact, her health consulting firm tried to push work requirements under the Obama administration, but was denied. States should ensure that career planning, job training, referral, and volunteering opportunities considered to meet the community engagement requirement, and job support services offered in connection with the requirement, take into account people's employability and potential contributions to the labor market.

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.

Verma also had a major role in designing an unorthodox approach to Medicaid in IN, which had asked the Obama administration to approve a work requirement.

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