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Feds Allow States to Impose Work Requirements on Medicaid Beneficiaries

14 January 2018

"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. It has also helped people work: Studies of Medicaid expansion in OH and MI found that the majority of beneficiaries said that getting health coverage helped them look for work or remain employed. Federal officials say work requirements will improve the overall health of beneficiaries, leading to lowered costs for taxpayers.

Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities, took to Twitter to voice her concerns about the new requirement. "People moving off Medicaid is a good outcome; we hope it means they don't need the program any more".

Pregnant women, children, the elderly and those in drug treatment would be excused.

More than 1.2 million non-disabled working-age adults receive Medicaid in IL, and most do work.

"Medicaid was designed as a health care program, to provide vulnerable members of our society with access to care they badly need", Ende wrote.

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Work requirements also are opposed by the Illinois Health and Hospital Association, which advocates for more than 200 hospitals and almost 50 health systems in the state.

The Obama administration balked at such waiver requests, but the Trump administration's new policy would rely on section 1115 of the Social Security Act, which allows waivers of certain provisions of the law if states can convincingly show that an initiative is both a research project and would promote the program's objectives.

States can also require alternatives to work, including volunteering, caregiving, education, job training and even treatment for a substance abuse problem.

Although there are no current work requirements, many nondisabled adults on MassHealth do work. Advocates for low-income people say they expect Kentucky's waiver to be approved shortly.

But he indicated the state has its hands full for now dealing with other Medicaid issues. Medicaid enrollees will probably have to go through a new process of demonstrating that they are meeting the work or "community engagement" standards. The Southern Poverty Law Center liberal advocacy group said it plans to file a legal challenge against the administration. Ron Wyden of OR, the top Democrat on the Senate committee that oversees Medicaid. The move was quickly criticized by Democrats. "A so-called "work requirement" does not support work, but instead puts a critical support for work at risk".

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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".

CMS also encourages states to consider a range of activities that could satisfy work and community engagement requirements.

While more than half of Medicaid recipients are children, there are still millions of adults who could face work requirements under the new CMS criteria. It also details that states should outline how they would support beneficiaries with limited employment opportunities (economically depressed area, rural area, transportation limitations, etc.). Unless states have significant research to show Verma's correct on causality, they may have a very hard time in federal court attempting to get clearance on this new executive override of Medicaid statutes.

Ten states - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin - have already filed applications with CMS to add work requirements to their Medicaid programs.

I doubt it-I think they're just cynical-but maybe. Although waivers can have lasting impact they don't amount to a permanent change in the program.

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Feds Allow States to Impose Work Requirements on Medicaid Beneficiaries