Trump Administration Will Let States Require People To Work For Medicaid

Centers for Medicare and Medicaid Services administrator during her Senate Finance Committee confirmation hearing in Washington on Feb. 16 2017. MUST CREDIT Bloomberg

She praised the move as one of freeing up flexibility for states, which Republicans say is sorely needed in the health-care system.

Rewriting the rules on health care for the poor, the Trump administration said Thursday it will allow states to require "able-bodied" Medicaid recipients to work, a hotly debated first in the program's half-century history.

Medicaid is the nation's largest public insurance program, providing health benefits to almost 74 million Americans, chiefly low-income adults. This would exclude individuals eligible for Medicaid due to a disability, elderly beneficiaries, children, and pregnant women. Besides employment, it can include job training, volunteering or caring for a close relative.

CMS administrator Seema Verma said the changes were made at the request of states seeking to make the 50-year-old health insurance program more responsive and "help people in achieving greater well-being and self-sufficiency".

"Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today's announcement is a step in that direction", she added.

The Centers for Medicare and Medicaid Services issued guidance making it easier for states to design and propose test programs that implement such requirements, according to a Reuters report. As I talk to Medicaid recipients, they want to get off public assistance; they want to have a better life.

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects determined by the Secretary to be likely to assist in promoting the objectives of the Medicaid program. "They want to develop programs that will help them break the chains of poverty and live up to their fullest potential". But administration officials argue that the work requirements will strengthen the program and improve health outcomes by encouraging Americans to train for and seek out jobs.

Ten states have applied for a federal waiver to add a work requirement - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

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. Why Is Their Governor Resisting?

Children account for more than two-fifths of those enrolled, with seniors or persons with disabilities accounting for an additional one-fifth, according to the Center on Budget and Policy Priorities. Many Republicans opposed the enlargement of Medicaid eligibility authorized under Obamacare.

For instance, the guidance notes that some Medicaid recipients may have trouble meeting these requirements because of poor health, substance abuse or high unemployment in their areas.

Still, critics fear a work requirement could have a chilling effect on people signing up for Medicaid or make it harder for people to get coverage. The work requirements will likely be challenged in court.

Louisiana is developing a proposal to impose work requirements on certain adult Medicaid recipients, as the Trump administration announced it will allow states to enact such provisions.

CMS also encourages states to consider a range of activities that could satisfy work and community engagement requirements.

CMS also advised states to make work requirements for Medicaid similar than those used with food stamps to "reduce the burden on both states and beneficiaries".

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