Feds issue guidance so states can pursue Medicaid work requirement
Jan 12, 2018, 03:20
Lambeth said he has been puzzled by the Trump administration's slow approach to the state Medicaid waiver request. States should try to align their Medicaid work requirements with similar conditions in other programs, such as food stamps and cash assistance. Many Republicans opposed the enlargement of Medicaid eligibility authorized under Obamacare.
Seema Verma, head of the CMMS, said work and community involvement can make a positive difference in people's lives and in their health.
The Health and Human Services Department outlined how states could reshape the program in a directive.
In order to implement any new policy based on the guidance, states would have to propose the changes through waivers and wait until they are granted federal approval. To qualify for a waiver, a state must provide a convincing justification that its experiment would "further the objectives" of Medicaid.
As of October 2017, almost 75m individuals were enrolled in Medicaid and the children's health insurance program (Chip).
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.
If Republicans truly cared about punishing "lazy" individuals soaking up money without having to work for it, they would be focusing their attention on "the idle rich", argued the Washington Post's Elizabeth Bruenig in a recent column. 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.
The critics are prepared to pounce on that rationale.
This will be the first work requirement in Medicaid's 52-year history. "It's not a good idea, and it's illegal".
Conservatives have long argued that social programs can be a disincentive to work and favor making safety net benefits contingent on working. It's a little like saying that rain causes clouds.
Plus, state Medicaid agencies won't get any additional federal funding to help recipients find and hold jobs, even though they are generally not equipped to develop, provide, and administer work support programs, said MaryBeth Musumeci, associate director of Kaiser's Program on Medicaid and the Uninsured.
"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.
Who could lose their health coverage as a result of this new guidance? "It is about taking away health insurance from low-income people".
"For the future of our country, we need all Americans to be active participants in their communities", she said in November.
The work requirement does not affect pregnant women, the elderly, the disabled, and, of course, children.
In Massachusetts, employers are facing a shortage of workers in a low unemployment economy and state officials are struggling to cover the cost of growing Medicaid enrollment in the face of threatened cuts in federal health care spending.
According to government statistics, 60 percent of non-disabled, working-age adults having a job, while almost 80 percent live with families that have at least one member in the labor force. That's because children - who make up almost half of Medicaid enrollees - are excluded.
The CMS guidance gives states a great deal of flexibility to define their own exceptions to a work requirement, as well as what counts toward work.
Under the guidance, community engagement activities would include skills training, education, job search, volunteering or caregiving.
People with substance abuse disorders such as opioid addiction.
It will allows states to deny Medicaid to able-bodied adults without a job, according to reports.
While more than 74 million people are enrolled in Medicaid, only a small fraction would be affected by the work requirement. "If we had fewer sick people and fewer poor people, that'd lower the Medicaid rolls".
The move is expected to impact millions of Americans who rely on the state-federal program to help get health coverage.
The Obama administration would have never approved such waivers, she added. "It will be interesting to see how states are going to make this work for people". IN rewrote its waiver request last summer, this time asking for federal permission to compel work activities. They're considered "demonstration programs" to test ideas.
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