Abril 20, 2018

Experts Question New Green Light On Medicaid Work Requirement

13 Enero 2018, 07:40 | Crisanna Felipe

Medicaid in Pennsylvania: the facts

Illinois Reviewing Medicaid Work Rule

The announcement comes only one day after the Centers for Medicare and Medicaid Services set forth new policy guidance, allowing individual states to propose and design test programs like the one approved in Kentucky.

However, Kristi Putnam, program manager for Kentucky's Medicaid overhaul request, has told Insider that people with chronic diseases - mental illness, chronic substance use disorder, blood clotting disorders - will remain eligible for Medicaid as they are exempt from the work requirements. They will have to figure out how to define the work requirement and alternative options, such as going to school or volunteering in some organizations; how to enforce the new rules; how to pay for new administrative costs; and how to handle the millions of enrollees likely to seek exemptions.

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.

Becoming the first-in-the-nation state is a victory for Kentucky's Republican governor, Matt Bevin, who during his 2015 campaign vowed to reverse the strong embrace of the Affordable Care Act by his Democratic predecessor.

Although each state could design these requirements differently - and some states might not add them at all - this new approach marks the first time Medicaid would require proof of work in exchange for health coverage.

But work requirements aren't the only idea that states have for health care, and it remains to be seen just how much flexibility CMS will give.

Ten states - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin - have submitted waivers that include work or community engagement requirements, according to the agency.

Requiring work for benefits is a GOP policy staple, and the party points to welfare and food stamps as a model.

Bradley said a work requirement was already in the 2016 Medicaid expansion bill.

The Maine Department of Health and Human Services previous year sought federal Medicaid officials' permission to require non-disabled, low-income adults enrolled in Medicaid to work as a condition of receiving coverage.

Democrats oppose the changes, arguing that they are just another step in Republican efforts to dismantle the safety net. Adam Mueller is an attorney at Indiana Legal Services, which helps people navigate the state's Medicaid program.

JAKE HARPER, BYLINE: Indiana submitted plans for a work requirement past year, and the approval letter could come any day now.

The Trump administration said states imposing work requirements must have plans to help people meet those requirements and should help arrange job training, child care and transportation as needed.

In the approval letter, CMS officials noted that voluntary employment programs have not been historically effective in other states.

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".

A bipartisan commission appointed to study the issue over the summer, led by Majority Leader Jeb Bradley, R-Wolfeboro, recommended that the program be continued but left numerous details to lawmakers - including how the state will pay for its 10 percent share of the expansion in 2020 and beyond. She criticized the Obama administration, saying it had focused on increasing Medicaid enrollment rather than helping people move out of poverty and into jobs. These measures will make it harder to stay in the state's good graces, and enrollees who miss deadlines can be punished by getting locked out of Medicaid for six-month windows.

The stated objective of the new guidance is to encourage work, which the Trump administration argues is ultimately good for people's health.

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