Major shift as Trump opens way for Medicaid work requirement

Kentucky Gov. Matt Bevin announces federal approval of Kentucky's Medicaid waiver in the Capitol Rotunda in Frankfort Ky. Friday Jan. 12 2018

This Kaiser Health News story can be republished for free (details).

The federal Centers for Medicare and Medicaid Services said it will allow states to implement work requirements for Medicaid recipients. Most of those states (KY, IN, AZ, AR, KS, ME, NH, NC, UT, WI) have already undertaken an Affordable Care Act Medicaid expansion, thereby bringing into the program childless, able-bodied adults who are above the poverty line.

The document says who should be excluded from the new work requirements - including children and people being treated for opioid abuse - and offers suggestions as to what counts as "work". Besides employment, it can include job training, volunteering or caring for a close relative.

The state was among 11 seeking work-requirement approvals from CMS. The agency's head, Seema Verma, said work and community involvement can make a positive difference in people's lives and in their health. Prior to Medicaid expansion, many of these workers simply went uninsured, and too often missed out on needed care - and they still do in states that haven't expanded the program. It is likely to prompt a lawsuit from patient advocacy groups, which claim the requirement is inconsistent with Medicaid's objectives and would require an act of Congress. And if they haven't done any of those things by that predetermined date, they'll get kicked out of Medicaid for six months and have to reapply.

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Bevin has said the program had become financially unsustainable under Obamacare, although the federal government covers the majority of its cost. The administration opposed work mandates for coverage. Why Is Their Governor Resisting?

Sununu said the announcement is good news for the state's pending waiver application. The current request would require able-bodied adults without dependents to work at least 20 hours a week.

The Kentucky Medicaid changes generally mimic those of neighboring IN, which altered its program IN 2015 under then-Gov. Almost 60 percent work either full time or part time, mainly for employers that don't offer health insurance. That's because children - who make up almost half of Medicaid enrollees - are excluded.

Kerri Wyland, a spokeswoman for Gov. Rick Scott, did not directly answer whether Scott would support work requirements or co-payments for the Medicaid program. This is a bit ironic because those welfare work requirements were loosened by President Obama, to the vocal dismay of his opponents. 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.

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The Trump administration, along with many Republican leaders in Congress, has long supported such a move.

In its guidance to states, CMS said they should consider how some communities have high unemployment rates and whether enrollees need to care for young children and elderly families.

In a 10-page letter to state Medicaid directors, CMS Director Brian Neale announced the new federal approach, "designed to assist states in their efforts to improve Medicaid enrollee health and well-being through incentivizing work and community engagement".

Medicaid is one of the largest expenses from the state's General Fund, with $8.4 billion of almost $32 billion in state spending paying for the program.

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Verma, who worked with Kentucky and IN on their work requirement waivers as a health consultant before joining the Trump administration, recused herself from the decision on those states' waiver requests. "Such programs may also, separately, be created to help individuals and families rise out of poverty and attain independence, also in furtherance of Medicaid program objectives".

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