New Guidelines on Medicaid Work Requirements

Trump administration allow work requirements in Medicaid

States can require Medicaid recipients to work, Trump administration says

States can impose a work requirement on some Medicaid recipients, the Trump administration said Thursday, announcing major changes that could push able-bodied people learn new skills or take jobs to get off the government dole.

The National Health Law Program (NHeLP) is pressing the Centers for Medicare and Medicaid Services (CMS) to give the public more time to comment on state proposals to impose work requirements in the Medicaid program.

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

To date, CMS has received demonstration project proposals from 10 states that include employment and community engagement initiatives: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

Instead of requiring states to increase and strengthen coverage, C.M.S. will now allow them to use waivers to promote "upward mobility" or "responsible decision-making".

The state's Medicaid program, which is called the Arizona Health Care Cost Containment System or AHCCCS, submitted its final application on December 19 to the federal government's Center for Medicare and Medicaid Services.

"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", Seema Verma, administrator of the agency, said in a statement.

Walthall said the guidance from CMS supports Indiana's plan to connect Medicaid recipients "to more meaningful community engagement". "Study after study shows that access to health care translates into higher earnings and better jobs", Winnie Stachelberg, of the Center for American Progress, said.

In addition, Neale said, researchers have found "strong evidence that unemployment is generally harmful to health", while employment tends to improve "general mental health".

In 2013, the inspector general for the state of Illinois Department of Healthcare and Family Services reported that state workers were failing to verify eligibility of many Medicaid recipients. Before enforcing those requirements, states must receive a waiver from CMS. So the legislature hired an independent vendor to do the job for them.

Critics of the policy have questioned whether it's legal to enforce work requirements in order to receive benefits under the government program and argued that it will impose barriers-not incentivize-individuals who use the program.

States can also require alternatives to work, including volunteering, caregiving, education, job training and even treatment for a substance abuse problem.

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.

Traditionally, Medicaid covered people not able to work - the elderly, children and the disabled. It also found large decreases in the share of people struggling to pay medical bills and relying on hospital emergency rooms for care.

Advocates say the work requirement and other changes will cause up to 95,000 Kentuckians to lose health coverage, according to the administration's own calculations.

When Ohio and MI expanded their Medicaid programs to broaden coverage, residents who became eligible found it easier to look for work, according to studies by the Ohio Department of Medicaid and the University of MI.

Steve Wagner with the Universal Health Care Action Network says there are many reasons why Medicaid beneficiaries may be unemployed, but being unmotivated is not at the top of the list.

What do the Republicans seeking to replace Wolf as governor say about the proposal?

It allowed states to provide coverage to anyone earning up to 138 percent of the federal poverty level (about $16,600 for an individual).

It's unclear how many people could be affected.

CMS officials said they did not have any estimates on how much Medicaid enrollment would drop as a result of the policy. "Conservatives who favor work requirements see Medicaid coverage as another form of government welfare benefit, like cash assistance, requiring reciprocal obligations from beneficiaries, and a disincentive to work".

For close to a year, the administration has signaled an interest in helping states that want to institute work requirements.

In addition, federal officials said, providing care for young children or elderly family members can sometimes qualify as work. "We don't have childless able-bodied working age adults in our system, so I don't know how that would transpose to us".

Under the proposed work requirement, people will have to prove that they're working or performing some other qualifying activity such as volunteering.

Latest News