Liberal-leaning groups had already hinted at challenging Medicaid work requirements in court before the Kentucky waiver was approved, and some of those same groups harshly criticized at the policies in the state's demonstration project. The Center for Children and Families at Georgetown University, citing the state's own projections, said the waiver provision could disqualify almost 100,00 Kentuckiansfrom Medicaid in the next five years.
Kentucky is the first state to be allowed to impose work requirements in its Medicaid program, a change that Gov. Matt Bevin has pushed. The administration opposed work mandates for coverage.
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.
Enrollees who will be exempt from this include full-time students, former foster care youth, pregnant women, people with an acute medical condition and primary caregivers. For example, the federal law only authorizes the secretary to allow states to ignore Medicaid's consumer protections when a state is implementing an experimental project created to promote the objectives of the Medicaid Act.
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.
When government handouts go to layabouts, it's not surprising that some people get angry.
"I applaud CMS and Governor Bevin for recognizing the unaffordable mess left behind by his predecessors and responding with innovative, common-sense steps to engage patients, improving health, and reduce the burden on Kentucky taxpayers", McConnell said in a written statement.
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"Instead", she continued, "it kicks people while they're down - taking away health care from unemployed or underemployed workers when they need it most".
Milliman, an Indianapolis-based actuarial firm hired by the state to evaluate its program, predicts just under 133,000 Hoosiers on the state's Medicaid expansion HIP 2.0 would be subject to the work requirement.
While more than 74 million people are enrolled in Medicaid, only a small fraction would be affected by the work requirement.
Children and non-disabled adults make up most of the enrollees, most spending is on the elderly and people with disabilities. "It's making people healthier that enables them to work", he said. The program allows beneficiaries to be locked out of benefits if they fail to produce proof they are following the rules, but they can get back in the system once they meet requirements for 30 days. Bevin said he expects the program to be fully implemented at the beginning of next year.
But Kentucky's lone Democratic Congressman, John Yarmuth of Louisville, called the move "dangerous and irresponsible" and said Bevin is "sabotaging" health coverage for 95,000 Kentuckians - the number of enrollees the Bevin administration predicts will be removed from Kentucky's Medicaid rolls over the next five years.
But critics suggest the move could leave many people uninsured.
"The truth is, people are going to lose Medicaid coverage", he said. He said his group is concerned work requirements could affect how the health plans operate. Rep. Travis Cummings, R-Orange Park, introduced a bill that would have required all Medicaid beneficiaries who are part of the state's "managed medical assistance" program to adhere to the same work requirements that now apply to families who receive temporary cash assistance. The activities include jobs training, community service or education.