States can require Medicaid recipients to work, Trump administration says

Posted January 12, 2018

The Trump administration is encouraging states to require "able-bodied" Medicaid recipients to work or volunteer in order to keep their health insurance coverage.

Ten states, mostly conservative ones, have applied for waivers involving requirements for jobs or community involvement for most Medicaid recipients.

The new policy comes as 10 states are already lined up, waiting for federal permission to impose work requirements on able-bodied adults in the program. South Dakota's governor said in his State of the State address Tuesday that he would also look to require certain recipients to work. Advocates for low-income people say they expect Kentucky's waiver to be approved shortly. Most who are not report reasons such as illness, caring for a family member or attending college. Recipients who meet the work requirements in the Supplemental Nutrition Assistance Program, commonly known as food stamps, and by the Temporary Assistance for Needy Families, must be considered in compliance with their state's Medicaid rules.

Walthall said the guidance from CMS supports Indiana's plan to connect Medicaid recipients "to more meaningful community engagement".

The governor's proposal to enact work requirements caught some off-guard, since Edwards administration officials with the state health department previously expressed concern about similar suggestions. The Center for Law and Social Policy says that would be both a shift of resources away from needed health care while still not being enough for anything "but an ineffective, low-touch job search program that primarily serves as an additional hoop for beneficiaries to jump through".

Kentucky, which has some of the poorest counties in the country, has seen its Medicaid enrollment double in the past three years after the state expanded eligibility under the ACA.

Critics argue that the move is aimed at cutting the number of people receiving government-funded Medicaid.

"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.

Thursday's administration guidance to states spells out safeguards that states should consider in seeking work requirements. Many of them have jobs that don't provide health insurance.

Adding a work requirement to Medicaid would mark one of the biggest changes to the program since its inception in 1966. "Health care is a right that shouldn't be contingent on the ideological agendas of politicians", said Sen. It's a little like saying that rain causes clouds. She told reporters in a call Thursday that it could lead to a decline in Medicaid enrollment.

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"There are a lot of different ideas, and a lot of ways to go about this", she said.

Verma also said that any drop in Medicaid rolls as a result of work requirements would stem from people no longer needing it.

The most recent federal figures show that Medicaid enrolls more than 68 million low-income Americans, including children, pregnant women, people with disabilities and the elderly.

A study from the non-partisan Kaiser Family Foundation found that nearly 60% of working-age adults on Medicaid are already employed. 36% said they were ill or disabled, 9% said they were retired, and 30% said they were taking care of family or their home.

The CMS guidance gives states a great deal of flexibility to define their own exceptions to a work requirement, as well as what counts toward work.

"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. "People who are elderly or disabled, and pregnant women and children, would be excluded".

"Medicaid needs to be more flexible so that states can best address the needs of this population".

"I give CMS some credit for listening to 10 states", she said. Many Republican-governed states declined to take part in the expansion.

"Work requirements don't help the unemployed or underemployed find work", Bolt notes, "it punishes them when they're down-which is exactly what the Trump administration wants to do".

IN is among 10 states with requests pending.