Published: Sun, January 14, 2018
World | By Paul Elliott

Experts Side-Eye New Green Light On Medicaid Work Requirement

Experts Side-Eye New Green Light On Medicaid Work Requirement

States will be allowed to create programs requiring Medicaid users to prove they are employed, training for a job, volunteering, or receiving treatment for substance abuse, according to new policy guidance from the Centers for Medicare and Medicaid Services.

CMS has released guidance for how states can seek Medicaid waivers imposing requirements for beneficiaries to work in order to receive coverage, a move which some healthcare groups quickly condemned and threatened to sue in order to stop.

Federal officials said they would support state efforts to require able-bodied adults to engage in work or other "community engagement activities" as a condition of eligibility for Medicaid.

The Trump administration and CMS claim that pregnant women, the disabled and the medically frail would be exempt from the work requirements.

An advocacy group in ME vowed to fight the waiver, arguing that it's illegal and that the current Medicaid program supports work by giving people access to health care, making them more likely to stay well enough to be employed. Under our proposal, people who receive Medicaid and are able bodied will need to work, be training for a new career, or volunteer.

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

Ironically, the first waiver request the Trump administration is likely to approve is from Kentucky, a state that has benefited enormously from Medicaid coverage for people facing opioid addiction. This addition to the Medicaid program was adopted by thirty-one states, as well as the District of Columbia.

But Senate Health and Human Services Appropriations Chairwoman Anitere Flores, R-Miami, said the Senate has not discussed requiring those now enrolled in the program to work. 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. Many of these individuals have qualified for Medicaid under the expansion of the program under the Affordable Care Act (ACA) that raised the threshold for eligibility to those earning up to 138 percent of the federal poverty line, or roughly $16,600 for an individual and $34,000 for a family of four. It laid out the basics for work requirements that would be attached to a proposal called "Carolina Cares", a bill with some Republican backing that contemplates a modified version of Medicaid expansion.

Rep. Frank Pallone Jr. of New Jersey, the senior Democrat on the House Energy and Commerce Committee, said that "the Trump administration's action today is cruel and a clear violation of both the Medicaid statute and long-standing congressional intent" for waivers, which he said were meant to "allow states to expand access to Medicaid, not restrict it".

Seema Verma, head of the CMMS said work and community involvement can make a positive difference in people's lives and in their health
Seema Verma, head of the CMMS said work and community involvement can make a positive difference in people's lives and in their health

"And most of those who aren't are children, the handicapped, people like that", Garcia said. Or that they're exempt.

The stated goal of the new guidance is to encourage work, which the Trump administration argues is ultimately good for people's health.

A Kaiser Foundation study shows 63 percent of the adult Medicaid recipients work. Barring the possibility that they find an employer sympathetic to his or her special needs, the only way to get out of this in-between space is to eventually become sick or disabled enough that they are eligible for Medicaid.

Federal Medicaid officials said that work requirements should be compared to work requirements in other programs like food stamps, now known as the Supplemental Nutrition Assistance Program, and the welfare program known as Temporary Assistance for Needy Families. So are the more than 10 million people on Medicaid because they have a disability.

'Medicaid needs to be more flexible so that states can best address the needs of this population, ' Verma said in a statement. However, if states align their work requirements with existing systems, such as those used with TANF and SNAP, it could decrease administrative costs.

But that's just not how it works, says Mary Gerisch, a member chair of the Rights & Democracy health care justice team.

The agency said it is encouraging states to consider a range of activities that could satisfy work and community engagement requirements.

CMS today announced new guidance that will support state efforts to improve Medicaid enrollee health outcomes by incentivizing community engagement among able-bodied, working-age Medicaid beneficiaries.

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