Trump's gift to GOP governors: States can now impose Medicaid work requirements


The Trump administration will allow states for the first time to impose work requirements on Medicaid recipients. "Federal Medicaid laws do not permit work requirements".

The new guidance allows states to apply for waivers, something that has never happened in Medicaid's 50-year history. "We must re-establish Medicaid's core mission of supporting the elderly, disabled and children".

"I see this as CMS giving states that are looking for flexibility, flexibility", Sudders said, using the acronym for the Centers for Medicare and Medicaid Services.

In a CMS call with reporters Thursday morning, Verma countered, "This policy is about helping people achieve the American Dream".

In its guidance, CMS pointed to studies that show working and volunteering can contribute to better health as justification that the requirement is in keeping with Medicaid's mission. The broadening of Medicaid to low-income adults under Obamacare - roughly 11 million have gained coverage under the health reform law's Medicaid expansion provision - further spurred GOP efforts. It also offers benefits like nursing homes and personal care services.

She said the new policy came about at the request of 10 different states including Kentucky, Maine, New Hampshire, Arizona, Indiana and Utah.

Taking away people's access to health care is a "terrible strategy if you want to promote work". According to the Kaiser Family Foundation, which is a nonpartisan research organization that focuses on health care, almost 60 percent of Medicaid recipients work either full time or part time, with the majority of the unemployed recipients citing reasons such as illness, attending school or caring for family members. That represents about 15 million people.

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A survey Kaiser conducted a year ago said those who weren't working said it was because of an illness or disability, home or family responsibilities, pursuit of an education, retirement or inability to find a job.

CMS did not directly address Medicaid expansion, which has been adopted by 31 states and the District of Columbia.

The federal government reimburses a portion of the money spent by states to provide Medicaid coverage for those who are eligible. They could find it difficult to apply for exempt status and verify it, which may need to be done monthly in some states, while those who are working may have a hard time verifying their hours, especially if they have variable shifts. Under the Affordable Care Act, the program has expanded in more than 30 states to cover residents with somewhat higher incomes. States must propose such changes through waivers and receive federal approval.

Verma, and proponents of the requirements view it differently. "For the Republicans fulminating rabidly under Obama that a president can not make up law and he is able to bypass Congress by executive memorandum, this is exactly that - on steroids".

Several states had previously addressed the notion of cutting off Medicaid benefits to people who can work, but don't, but the idea was repeatedly refused by former President Barack Obama's government, CNN reported Thursday.

Other groups criticizing the Trump administration's plans included Public Citizen, Families USA and the advocacy arm of the American Cancer Society.

"People who participate in activities that increase their education and training are more likely to find sustainable employment, have higher earnings [and] a better quality of life", Verma said.