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Trump Opens Way for States to Seek Work Requirement for Medicaid

12 January 2018

The Centers for Medicare and Medicaid Services, a division of the Department of Health and Human Services, issued new guidelines on Thursday for states that want to comply, NPR reported.

Health insurance reforms initiated during Barack Obama's presidency raised the income cap for access to Medicaid, allowing millions of low-income earners to join the Medicaid rolls.

Former President Obama, under the Affordable Care Act, allowed states to expand the program to include low-income adults who have jobs that don't provide health insurance.

The move is expected to impact millions of Americans who rely on the state-federal program to help get health coverage.

Gov. John Bel Edwards said this week that his administration is "actively working" on the concept, which would require federal approval to be enacted.

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Ten states - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin - requested the ability to put the work requirements in place, according to the CMS statement.

"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.

CMS administrator Seema Verma called it "incentivizing community engagement" in a tweet sent out shortly after the new guidelines were released.

Certain Medicaid populations would be exempt from the rules, including those with disabilities, the elderly, children, and pregnant women.

Mary Beth Musucemi, associate director of the Kaiser Family Foundation's Program on Medicaid and the Uninsured, said the new approach "will penalize individuals by having them lose health coverage, rather than incentivize them, as a voluntary program with adequately funded supportive services necessary to overcome barriers would".

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"All of this on paper may sound reasonable, but if you think about the people who are affected, you can see people will fall through the cracks", said Judy Solomon of the Center on Budget and Policy Priorities, which advocates for the poor.

Contrary to the right-wing trope that recipients of Medicaid are unemployed moochers, a Kaiser Family Foundation study published last month found that 80 percent of adult Medicaid recipients "live in working families, and a majority are working themselves".

The state and federal comment periods have closed for at least seven states that have already asked CMS to allow them to institute work requirements, according to NHeLP. "The analysis noted that, 'More than one-third of those not working reported that illness or disability was the primary reason for not working. almost nine in ten (88%) non-SSI Medicaid adults who report not working due to illness or disability has a functional limitation, and more than two-thirds (67%) have two or more chronic conditions such as arthritis or asthma'".

Brian Neale, director of the federal Medicaid office, believes the new program will be greatly helpful for those involved.

The debate about work requirements doesn't break neatly along liberal-conservative lines. 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.

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CMS said the requirements "should take into consideration areas of high unemployment or care giving for young children or elderly family members". Those deemed "medically frail" and pregnant women will be exempted, and states must prove they are not inappropriately denying coverage to those with disabilities.

Trump Opens Way for States to Seek Work Requirement for Medicaid