Trump Administration Moves to Allow States to Impose Medicaid Work Requirements

The Trump administration's move allows states to deny medicaid if an able-bodied adult doesn't have a job

The new policy guidance provides design support for state 1115 demonstrations looking to add flexible work requirements consistent with standard federal Medicaid rules.

Far from requiring full-time work hours, the new policy states that eligible individuals will spend twenty hours a week in work-related activities, which may include job training or treatment for opioid addiction.

"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", said Verma.

In a letter sent to State Medicaid Directors, Brian Neale, director of the Centers for Medicare and Medicaid Service, said the changes are created to promote "better mental, physical and emotional" health of recipients. For example, the guidance suggests that states could "count time spent in treatment toward [the work] requirement, or exempt a person going through inpatient or outpatient treatment from the requirement altogether". They are: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

An HHS official, who spoke on the condition of anonymity because the official had not been authorized to discuss the developments, said the agency may approve Kentucky's request as early as Friday.

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It was expanded under President Barack Obama, with an option that has allowed states to cover millions more low-income adults; many have jobs that don't provide health insurance. It said states should exempt certain populations, such as people with disabilities, and should consider issues like substance misuse and regionally high unemployment rates.

Seema Verma, CMS' administrator, said in a statement that the controversial plan aims "to improve Medicaid enrollee health outcomes by incentivizing community engagement among able-bodied, working-age Medicaid beneficiaries".

Opponents of the proposal say that it opens up the ability for at-risk patients to get denied access and will make it more hard for worthy recipients to get access to care.

This will be the first work requirement in Medicaid's 52-year history.

Verma stressed that the administration is providing an option for states to require work, not making it mandatory across the country.

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The policy shift is a significant departure from the Obama administration, which denied state efforts to impose work requirements in order to boost enrollment rolls. So are the more than 10 million people on Medicaid because they have a disability.

'Medicaid is a health program that is supposed to serve people who don't otherwise have coverage'.

A study from the non-partisan Kaiser Family Foundation found that nearly 60% of working-age adults on Medicaid are already employed. 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. The ACA allowed states to expand eligibility to low-income adults without children, with the federal government covering most of the cost. States should ensure that career planning, job training, referral, and volunteering opportunities considered to meet the community engagement requirement, and job support services offered in connection with the requirement, take into account people's employability and potential contributions to the labor market.

Verma also had a major role in designing an unorthodox approach to Medicaid in IN, which had asked the Obama administration to approve a work requirement.

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