Federal Government to Implement Work Requirements for Medicaid Recipients

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The Trump administration early Thursday initiated a pivotal change in the Medicaid program, announcing that for the first time the federal government will allow states to test work requirements as a condition for coverage. Specifically, the ability to impose a work requirement among working-age, non-pregnant Medicaid beneficiaries not eligible for Medicaid on the basis of a disability was sought by 10 states as part of their application for a broader set of Medicaid waivers.

He also estimates about 95,000 people will lose their Medicaid coverage either by not complying with the work and community engagement requirements or by losing their eligibility because they make too much money. Reuters noted that decision to allow work requirements faces probable legal challenges. "People who participate in activities that increase their education and training are more likely to find sustainable employment, have higher earnings, a better quality of life, and, studies have shown, improved health outcomes".

A bipartisan commission appointed to study the issue over the summer, led by Majority Leader Jeb Bradley, R-Wolfeboro, recommended that the program be continued but left numerous details to lawmakers - including how the state will pay for its 10 percent share of the expansion in 2020 and beyond. In practical terms, they would represent new requirements for beneficiaries in those states.

"We expect that fewer people will be able to stay enrolled in coverage due to all of the red tape and penalties they'll encounter", said Emily Beauregard, executive director for Kentucky Voices for Health, an advocacy group.

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A detailed evaluation of Medicaid expansion in OH by that state's Department of Medicaid explains how it pays off for workers and taxpayers. Democrats, health providers and patient groups say the measure adds another stumbling block for people to keep their coverage. The report notes that implementing the work requirements "can be error prone", resulting in some people being denied benefits they should get and others receiving benefits they're not really eligible for. If an individual already satisfies a work requirement in Supplemental Nutrition Assistance Programs (SNAP or "food stamps") or Temporary Assistance for Needy Families (TANF), then they will automatically satisfy the Medicaid requirement. Most adult Medicaid recipients who do not work reported major impediments as the reason, according to Kaiser.

Health & Family Services Secretary Vickie Yates Glisson says the Kentucky HEALTH program will start in July, and that it is not a "one size fits all" solution. Most of those states (KY, IN, AZ, AR, KS, ME, NH, NC, UT, WI) have already undertaken an Affordable Care Act Medicaid expansion, thereby bringing into the program childless, able-bodied adults who are above the poverty line. But Rosenbaum notes the absurdity of arguing that keeping people from health care will make them more likely to be able to work. Pregnant women and children will be exempt from that cost sharing. But in a speech to the nation's Medicaid directors in November, Verma said adding non-disabled adults to Medicaid was a mistake for a program created to help children, the disabled and pregnant women.

But Sara Rosenbaum, a law professor at the Milken Institute School of Public Health at George Washington University, said the letter doesn't actually bar states from kicking people with substance abuse problems off their insurance. Officials in several other states have said they are interested in the idea. This is a bit ironic because those welfare work requirements were loosened by President Obama, to the vocal dismay of his opponents.

Kaiser Health News (KHN) is a national health policy news service.

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