Trump to let states pursue Medicaid work requirements

Adam Berry  Getty Images

Adam Berry Getty Images

The Trump administration announced Thursday it would allow states to impose work requirements on "able-bodied" adults who receive Medicaid.

Some 65% of men on Medicaid are working, while 56% of women are employed.

Many patient advocates note that only a fraction of the people covered by Medicaid are of working age, nondisabled and now unemployed. “Programs that assist people in finding and keeping work are effective, not programs that penalize them by stopping health insurance or blocking them from getting health coverage in the first place.”. Medicaid is a means-based program, meaning that only low-income people (the income cut-off varies by state) will be affected by these changes.

“Whether it is a job, training, volunteering, substance abuse treatment, additional education or another opportunity, becoming an active and productive member of the community is an important part of healthy living, ” she said in a statement.

CMS Administrator Seema Verma said 10 states have submitted demonstration project proposals: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

The change was the most popular among potential changes to Medicaid, including requiring beneficiaries to undergo drug tests (64 percent).

In his State of the State address Tuesday, Gov. Phil Bryant of MS, a Republican, said he supported a "workforce requirement" for able-bodied adults on Medicaid.

IN is among 10 states with requests pending.

Critics of the Trump administration's approach note that a growing body of evidence shows that Medicaid health coverage is helping many Americans improve their health and their finances, not holding them back, as Verma and other have suggested.

"States ... want more flexibility to engage their working-age, able-bodied citizens on Medicaid", Verma told a gathering of state Medicaid directors in November.

Why is the Trump administration talking about a work requirement?

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President Obama vastly expanded the program to people making slightly above the poverty line and balked at state proposals to impose work requirements, saying they were inconsistent with Medicaid's goals of providing coverage.

But critics of work requirements say they contradict the core objective of Medicaid, which is to help low-income people access medical benefits, and could end up making it even harder for people to land jobs if they end up being sicker.

The Trump administration wants Medicaid beneficiaries to prove they are working or participating in "community engagement activities", which like most such barriers is created to jettison people from the program.

Most Medicaid recipients are children, seniors or people with disabilities who would be exempt from work requirements.

Medicaid is only available to people over 65, the disabled, and the nation's poorest people who don't get health care any other way.

Some 60% of working age, non-disabled Medicaid enrollees are working, according to a new report from the Kaiser Family Foundation. People whose income allows them to be eligible for Medicaid nearly certainly can not afford these upfront costs.

The bill also would have required Medicaid enrollees to pay monthly premiums to remain enrolled in the managed medical assistance program, which involves enrolling in managed-care plans.

Since congressional Democrats can not stop the administration from issuing waivers, this battle now moves to the states.

CMS said it would support state efforts to align Medicaid work and community engagement requirements with Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families (SNAP and TANF). Additionally, the guidance details that states can not accrue savings from loss in enrollment due to work requirements, which means that states will need to pay for any work requirement administrative burden, such as determining if an individual is working, developing an enrollee reporting system and employment supportive services, etc. Its existing initiative to connect Medicaid recipients with employment services is voluntary and not enough people participate, the state's proposal said.

People with a disability, pregnant women, elderly people, children, and the "medically frail" must also be exempted from the requirement, according to the new rule. That could include job training, career planning or volunteer activities.

Recipients who aren't working were mostly taking care of a relative, attending school or too sick.

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