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Trump Administration Moves to Allow States to Impose Medicaid Work Requirements

14 January 2018, 03:18 | Joan Schultz

Trump just made another big move that could hit his voters hard

Centers for Medicare and Medicaid Services administrator during her Senate Finance Committee confirmation hearing in Washington on Feb. 16 2017. MUST CREDIT Bloomberg

Pallone said that "the Trump administration's action today is cruel and a clear violation of both the Medicaid statute and longstanding congressional intent" for waivers that were meant to "allow states to expand access to Medicaid, not restrict it".

The federal government is expected to approve Kentucky's work requirement proposal Friday and Indiana's sometime this month.

She praised the move as one of freeing up flexibility for states, which Republicans say is sorely needed in the health-care system. The guidance also includes caregiving as one of the activities. "As Medicaid has expanded to able-bodied individuals, the needs of this population are even more imperative".

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. They fear many recipients will be unable to meet the mandate and be left uninsured.

For instance, the guidance notes that some Medicaid recipients may have trouble meeting these requirements because of poor health, substance abuse or high unemployment in their areas.

Federal law states what an American has to do to qualify for Medicaid, he said. States must propose such changes through waivers and receive federal approval. "Such programs may also, separately, be created to help individuals and families rise out of poverty and attain independence, also in furtherance of Medicaid program objectives".

A Health Affairs analysis found that if work requirements were applied to Medicaid nationwide, 11 million enrollees would be at risk of losing coverage. Federal officials say work requirements will improve the overall health of beneficiaries, leading to lowered costs for taxpayers. And CMS head Seema Verma has always been a proponent of such measures. "The last thing Americans who have fallen on hard times need is to lose their health care so Washington Republicans can take a political victory lap at their expense", he said.

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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. They want to develop programs that will help them break the chains of poverty and live up to their fullest potential. Its existing initiative to connect Medicaid recipients with employment services is voluntary and not enough people participate, the state's proposal said.

Pregnant women, children, the elderly and those in drug treatment would be excused.

"For the future of our country, we need all Americans to be active participants in their communities", she said in November.

Vanita Gupta, president and CEO of The Leadership Conference on Civil and Human Rights, said, "Imposing a work requirement to be eligible for Medicaid not only fails to further the goal of providing healthcare, but also undermines the underlying objective. Those days are over". The letter left out whether states could require frequent check-ins or updated paperwork from recipients, for example, and then cut off benefits if they fell behind.

According to a recent analysis by the nonprofit Kaiser Family Foundation, 6 in 10 of the almost 25 million working-age, nondisabled adults on Medicaid are already working full time or part time. The vast majority of those who aren't working have an illness or disability, are caring for a family member, or are in school.

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. Those who are deemed "medically frail" or have an acute condition that prevents them from working are also exempt.



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