Trump admin opens door to let states impose Medicaid work requirements

Trump admin opens door to let states impose Medicaid work requirements

Trump admin opens door to let states impose Medicaid work requirements

The Trump administration Thursday offered a roadmap for states seeking federal backing for waivers imposing the work requirements on the low-income adults in the Medicaid program.

"To qualify for a waiver, a state must provide a convincing justification that its experiment would "further the objectives" of Medicaid", notes the Washington Post's Amy Goldstein.

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

States would have to build new systems to determine who is subject to work requirements and verify whether beneficiaries fulfilled them, said LaDonna Pavetti, vice president at the Center on Budget and Policy Priorities, a left-leaning think tank. To achieve the objectives of Medicaid, state programs should be created to promote better physical and mental health.

While more than 74 million people are enrolled in Medicaid, only a small fraction would be affected by the work requirement.

"It is telling that both the Trump administration and the states proposing work requirements also have proposed major cuts to Medicaid that would take away coverage from millions of people", said Eliot Fishman, senior director of health policy of Families USA.

The National Association of Medicaid Directors, a nonpartisan group representing state officials, said in a statement there's no consensus on whether work requirements are the right approach.

She said the new policy came about at the request of 10 different states including Kentucky, Maine, New Hampshire, Arizona, Indiana and Utah.

Verma insisted the Trump administration wants to give states leeway to make its own decisions and try out their own ideas.

Thursday's guidance stipulates that pregnant women, disabled people and the elderly should be excluded from the new requirements and that factors including child care or elder care burdens should be factored in.

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States are also required to incorporate opioid and substance abuse treatment programming into 1115 demonstrations with flexible work requirements.

According to the Kaiser Family Foundation, 40 percent of Medicaid recipients nationwide, or 9.8 million, do not work, while 42 percent work full time and 18 percent work part time.

"Our policy guidance was in response to states that asked us for the flexibility they need to improve their programs and to help people in achieving greater well-being and self-sufficiency", Verma said.

The Nov. 20 amendment by N.C. DHHS includes elements of House Bill 662, known as "Carolina Cares," that was introduced during the 2017 legislative session by Rep. Donny Lambeth, R-Forsyth.

CMS administrator Seema Verma called it "incentivizing community engagement" in a tweet sent out shortly after the new guidelines were released. "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'". Consumer advocates and health policy experts fear that such a requirement could prove a big hurdle for many recipients, leaving them without the care they need. She was an architect of Kentucky's waiver application once a Democratic governor who had eagerly embraced the ACA was succeeded by Matt Bevin, a Republican who campaigned on a pledge to reverse the program expansion there. "People who participate in activities that increase their education and training are more likely to find sustainable employment, have higher earnings, a better quality of life, and, studies have shown, improved health outcomes".

"Among the adult Medicaid enrollees who were not working, most report major impediments to their ability to work including illness or disability or care-giving responsibilities", the study adds. They fear many recipients will be unable to meet the mandate and be left uninsured.

CMS Administrator Seema Verma touted the guidance, tweeting that "We owe beneficiaries more than a #Medicaid card; we owe them the opportunity and resources to connect with job skills, training and employment so they can rise out of poverty".

"The goal should be to assist folks, who are able bodied, to become members of the work force".

The agency is expected to start approving state waivers promoting "community engagement activities" in coming weeks, according to CMS.

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