States can require Medicaid recipients to work, Trump administration says

Kristopher Drake
January 12, 2018

Verma stressed that the administration is providing an option for states to require work, not making it mandatory across the country.

Kentucky will likely become the first state to receive a waiver, which could happen as soon as Friday, the Washington Post reported.

The historic move would be a significant change in how the government health insurance program operates and would fulfill a longtime Republican goal.

"Under the rules, states can require Medicaid beneficiaries to work, volunteer or participate in job training", reports NPR. The guidance also includes caregiving as one of the activities. "People moving off Medicaid is a good outcome; we hope it means they don't need the program any more".

Seema Verma, head of the federal centers for Medicare and Medicaid services, said work and community involvement can make a positive difference to people's health and lives. They fear many recipients will be unable to meet the mandate and be left uninsured. "The work requirement will deny care to untold numbers of Americans", Public Citizen President Robert Weissman said in a statement.

The agency's guidance provides states with a lot of flexibility in designing their programs and highlights that many recipients may need additional considerations.

Health groups and advocates for the poor - including the National Center for Law and Economic Justice and the American Lung Association - dispute Verma's contention that the Centers Medicare and Medicaid Service has the authority to grant such requests.

States have been advised to take into account recipients who look after an elderly relative or children. Pregnant women will also be exempt. That could mean counting time spent in drug treatment as a form of "community engagement". Many governors, including Republican ones, have defended the Medicaid program as being critical to addressing the substance abuse crisis. They also hearken back to the program's original intent, he added, "as temporary assistance to try to help people get back on their feet, not a permanent subsidy for someone's lifestyle, if they're capable of working". However, they will not be allowed to use federal Medicaid funding to finance these services.

States will be required to describe strategies that assist individuals in looking for work and what the state will do to connect Medicaid enrollees to employment or community programs.

Republicans have long wanted to add work requirements to the Medicaid program, which covers almost 75 million low-income children, adults, elderly and disabled Americans.


Former President Obama, under the Affordable Care Act, allowed states to expand the program to include low-income adults who have jobs that don't provide health insurance.

Cobey Culton, spokesman for N.C. Department of Health and Human Services, said the department is "reviewing the new guidance to understand how it may impact us".

Verma, and proponents of the requirements view it differently. Almost 60 percent work either full time or part time, mainly for employers that don't offer health insurance. These able-bodied men and women are the ones who will be required to find work in order to keep their Medicaid benefits. Now, she is in a position to approve them.

'There's never been a work requirement in Medicaid, it's only been in recent years that states have raised the possibility of having one, ' she said.

The move is a major shift in policy, but not a surprise for the Trump administration. "Those days are over".

Medicaid doesn't now require recipients to have a job.

Adding work requirements for Medicaid may not drastically affect enrollment totals, since 78 percent of Medicaid beneficiaries are working, according to an analysis from the Kaiser Family Foundation (KFF). "The analysis noted that, 'More than one-third of those not working reported that illness or disability was the primary reason for not working. almost nine in ten (88%) non-SSI Medicaid adults who report not working due to illness or disability has a functional limitation, and more than two-thirds (67%) have two or more chronic conditions such as arthritis or asthma'".

The health coverage was originally created for people with medical issues who could not physically hold jobs, and the new update will not change for those who fit into that category.

The majority of those polled by the nonpartisan foundation opposed the Trump administration's proposed cuts to Medicaid, but 70% said they supported some sort of work requirement.

"This action by the Trump administration goes after people who are just trying to get by", Democratic U.S. Senator Ron Wyden of OR said. Some Medicaid recipients say the coverage has enabled them to get healthy enough to return to work. In the end, that state included in its Medicaid expansion only an encouragement of voluntary efforts by beneficiaries to train for work or find jobs. Taking away people's access to health care is a "terrible strategy if you want to promote work".

Other reports by Ligue1talk

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