Trump administration allows states to make Medicaid recipients work

Marie Harrington
January 12, 2018

The Trump administration has announced it is offering a path for states that want to seek work requirements on Medicaid recipients.

The legal issue is that states must obtain federal permission to depart from Medicaid's usual rules, using a process known as "1115 waivers" for the section of the law under which the program exists.

The major policy shift seeks to overhaul the long-standing social contract between state and federal governments and poor citizens who rely on their services.

The end goal of Medicaid oversight is services being put into the hands of three statewide managed-care organizations, likely prepaid health plans from commercial insurers, and up to 12 provider-led entities, likely to involve not-for-profit health-care systems.

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.

"The governor strongly supports Medicaid expansion and has been fighting for it since the day he took office, and he realizes that most people who would qualify already are working", Cooper spokeswoman Sadie Weiner said Thursday via email.

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. Advocates for low-income people say they expect Kentucky's waiver to be approved shortly. Under the Affordable Care Act, the program has expanded in more than 30 states to cover residents with somewhat higher incomes.

"Medicaid needs to be more flexible so that states can best address the needs of this population", she said in a statement. Aligning requirements across these programs may streamline eligibility and reduce the burden on both states and beneficiaries and help beneficiaries succeed in meeting their work and community engagement responsibilities.

CMS Administrator Seema Verma said in her letter that employment and higher earnings are associated with improved mental health and overall wellbeing. "We need to work together to find ways to improve the program, instead of restrict it, so that it better provides health care coverage to those who need it".

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The policy would exclude individuals who are elderly or disabled, pregnant women and children.

Solomon, the advocate for low-income people, said the federal government's waiver authority doesn't provide carte blanche to ignore the basic purposes of the program, and promoting work has not been on that list up to now.

Many Medicaid recipients are employed.

Almost eight in 10 adults in Medicaid are already in working families, and most are working themselves, according to the Kaiser Family Foundation.

BREAKING: Trump administration is allowing states to terminate automatic, guaranteed Medicaid coverage for people with disabilities, the medically frail, and people who can't find jobs. The decision may mean some changes for the Ohio's Medicaid program.

"M$3 ore than one-third of Medicaid beneficiaries who aren't working report that illness or a disability is the main reason, 28 percent report that they're taking care of home or family, and 18 percent are in school", reports the Center of Budget and Policy Priorities. That's because children - who make up almost half of Medicaid enrollees - are excluded.

CMS Administrator Seema Verma touted the guidance, tweeting that "We owe beneficiaries more than a #Medicaid card; we owe them the opportunity and resources to connect with job skills, training and employment so they can rise out of poverty". And "it is illegal because it contravenes Medicaid's objective of providing medical assistance to low-income and vulnerable people".

Verma also had a major role in designing an unorthodox approach to Medicaid in IN, which had asked the Obama administration to approve a work requirement.

Other reports by TheSundaySentinel

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