Trump White House clears path for Medicaid work requirement

Trump White House clears path for Medicaid work requirement

Seema Verma, the agency's administrator, said the policy guidance came in response to requests from at least 10 states that have proposed requiring some Medicaid recipients to work or participate in activities that may include skills training, education, job search, volunteering, or caregiving.

Ten states, all of which have Republican governors, recently applied for waivers to impose work requirements.

Kentucky, which has some of the poorest counties in the country, has seen its Medicaid enrollment double in the past three years after the state expanded eligibility under the ACA.

Seema Verma, head of the Centers for Medicare and Medicaid Services, issued new guidance meant to help states design programs encouraging "able-bodied, working-age Medicaid beneficiaries" to participate in skills training, education, job search, volunteering or care giving.

"Medicaid needs to be more flexible so that states can best address the needs of this population", Seema Verma, the Medicaid and Medicare chief, said in a statement.

'Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries'.

Health insurance reforms initiated during Barack Obama's presidency raised the income cap for access to Medicaid, allowing millions of low-income earners to join the Medicaid rolls.




The Centers for Medicare and Medicaid Services, issued guidance making it easier for states to design and propose test programs that implement such requirements.

The shift under Trump could draw legal challenges from health care, rights or seniors' groups. To achieve the objectives of Medicaid, state programs should be created to promote better physical and mental health.

"This new guidance paves the way for states to demonstrate how their ideas will improve the health of Medicaid beneficiaries, as well as potentially improve their economic well-being", CMS Deputy Administrator and Director for the Center for Medicaid and CHIP Services Brian Neale said. He said it's not clear what problem a Medicaid work requirement would solve, and that there are better ways to help people find jobs or reduce the number of people receiving Medicaid. State DHHS would be "required to make reasonable modifications for individuals with opioid addiction and other substance use disorders".

Contrary to the right-wing trope that recipients of Medicaid are unemployed moochers, a Kaiser Family Foundation study published last month found that 80 percent of adult Medicaid recipients "live in working families, and a majority are working themselves". Recipients who meet the work requirements in the Supplemental Nutrition Assistance Program, commonly known as food stamps, and by the Temporary Assistance for Needy Families, must be considered in compliance with their state's Medicaid rules.

The letter to state Medicaid directors opens the door for states to cut off Medicaid benefits to Americans unless they have a job, are in school, are a caregiver, volunteer or participate in other approved forms of "community engagement" - an idea that some states had broached over the past several years but that the Obama administration had consistently rebuffed. The remaining 27 percent were not working, but two-thirds of them had a chronic mental or physical health condition, and one quarter of them said this condition interfered with their ability to function on a daily basis. This addition to the Medicaid program was adopted by thirty-one states, as well as the District of Columbia.

Thursday's administration guidance spells out safeguards that states should consider in seeking work requirements.

The state's Medicaid department is already in the process of applying for a waiver to add work requirements, which was part of the budget passed past year.

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