Fed announces major shift on Medicaid work requirement policy

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The Trump administration said Thursday that states will soon be permitted to impose work requirements on Medicaid recipients.

According to Seema Verma, head of the Centers for Medicare and Medicaid Services, work and community involvement can make a positive difference in people’s lives and improve their health. But liberal lawmakers likely won’t see it that way.

“Health care is a right that shouldn’t be contingent on the ideological agendas of politicians,” declared Sen. Ron Wyden of Oregon, the top Democrat on the Senate committee that oversees the program. “Today the Trump administration has taken a big step in the wrong direction.”

According to a report from The Associated Press, Medicaid covers roughly 1 in 5 Americans, making it the largest government health insurance program. It was expanded under President Barack Obama, with an option allowing states to cover millions more low-income adults who often work jobs that don’t provide health insurance.

People are not legally required to hold a job to be on Medicaid, but states are sometimes able to seek federal waivers to test new ideas for the program.

According to the AP report: “The administration’s latest action spells out safeguards that states should consider to obtain federal approval for waivers imposing work requirements on ‘able-bodied’ adults. States can also require alternatives to work, including volunteering, caregiving, education, job training and even treatment for a substance abuse problem.”

Ten states have already applied for waivers involving work requirements or community involvement:

  • Arizona
  • Arkansas
  • Indiana
  • Kansas
  • Kentucky
  • Maine
  • New Hampshire
  • North Carolina
  • Utah
  • Wisconsin

Verma pointed out, “We see people moving off of Medicaid as a good outcome.”

A study from the nonpartisan Kaiser Family Foundation found that most working-age adults on Medicaid are already employed. Nearly 60 percent work either full time or part time, mainly for employers that don’t offer health insurance. Verma explained that they would not be affected by the new policy.

Kaiser polling last year found that 70 percent of the public expressed support for allowing states to impose work requirements on Medicaid recipients.

Thursday’s administration guidance to states contains several safeguards, including:

  • An exemption for pregnant women, disabled people and the elderly.
  • Taking into account hardships for people in areas with high employment, or for people caring for children or elderly relatives.
  • Allowing people under treatment for substance abuse problems to have their care counted as “community engagement” for purposes of meeting a requirement.

The administration noted that states must fully comply with federal disability and civil rights laws, to accommodate disabled people and prevent those who are medically frail from being denied coverage. States should try to align their Medicaid work requirements with similar conditions applying in other programs, such as food stamps.

Work requirements would be decided by individual states, Verna noted.

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