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Kentucky Becomes First State To Require Work For Medicaid Recipients

13 January 2018

The state was among 11 seeking work-requirement approvals from CMS. Many of them have jobs that don't provide health insurance.

The available research on requiring Medicaid beneficiaries to pay monthly premiums shows that premiums discourage people from enrolling in Medicaid, causing them to go without health coverage. It also states explicitly that states can't get federal Medicaid money for services like childcare and transportation that people might need to get back to work.

Trump's new direction can be reversed by a future administration. In a letter sent to Kentucky state officials on Friday, the Trump administration made clear it would approve similar waivers for other states. "Those days are over". The states are Arizona, Indiana, Kansas, Maine, New Hampshire, North Carolina, Utah and Wisconsin. Parents of poor children in some non-expansion states don't qualify if they make, while others range from half all the way up to 133 percent.

In Arkansas, state Department of Human Services spokesman Amy Webb said the government's guidance "seems to be in line with how we want to move in Arkansas".

"During the campaign, Bevin pledged to end Kentucky's highly successful Medicaid expansion, but as governor, he did not have the courage to do it", the congressman said.

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Although each state could design these requirements differently - and some states might not add them at all - this new approach marks the first time Medicaid would require proof of work in exchange for health coverage. About 70 percent of Americans say they support states imposing a work requirement on non-disabled adults, according to a Kaiser Family Foundation poll a year ago.

Many Medicaid recipients are already employed. Under state work requirements, people have to verify their work status or their qualification for an exemption, according to, associate director of Kaiser Family Foundation's Program on Medicaid & the Uninsured. "Such programs should be created to promote better mental, physical, and emotional health in furtherance of Medicaid program objectives". Requiring recipients to work would be illegal because it is not consistent with Medicaid's objectives, said Leonardo Cuello, health policy director of the National Health Law Program.

While Bevin said that Kentucky's new program, called HEALTH (Helping to Engage and Achieve Long Term Health) would improve Kentuckians' health outcomes, critics, including U.S. Rep. John Yarmuth, D-Ky., said it would kick tens of thousands of people off health insurance.

The guidance release Thursday pointed to several studies that said unemployment is harmful to one's health and can prompt higher rates of hospital admission and death, as well as poorer general and mental health. Or they're caring for a child or family member, or they're sick or disabled.

SARA ROSENBAUM: Or they're looking for work.

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Dr. Richard Pan, a California state senator and pediatrician in Sacramento who sees Medicaid patients, said the idea just "doesn't make sense".

Medicaid has played a big role in combating the opioid epidemic, paying for a wide range of treatments and medications.

ROSENBAUM: There is this very, very tiny slice of people who can work and simply choose not to work and, you know, apply for public assistance.

"Somewhere along the way paperwork gets lost, there's a miscommunication", said Adam Mueller, who heads up advocacy efforts for Indiana Legal Services, a nonprofit that helps people navigate Indiana's Medicaid. That leaves plenty of chances to fall through the cracks of a work requirement.

President Donald Trump listens to Seema Verma, administrator of the Centers for Medicare and Medicaid Service, during a healthcare panel in the Roosevelt Room at the White House on March 22, 2017.

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SHAPIRO: This story is part of an NPR partnership with WFYI and Kaiser Health News.

Kentucky Becomes First State To Require Work For Medicaid Recipients