Potential major changes coming for those on Medicaid

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Today's announcement isn't about work: "it is about taking away health insurance from low-income people".

In a letter to state Medicaid directors, the White House is signaling a willingness to approve state requests to require people seeking health coverage through the Medicaid program to have a job or participate in other approved forms of "community engagement".

States would need to do so through a specific waiver with CMS. Ten states have requested waivers to require work in exchange for benefits, with some exceptions. Federal officials say work requirements will improve the overall health of beneficiaries, leading to lowered costs for taxpayers. Estimated spending on the program will be just under $27 billion this year, making it the fifth-largest program in the nation in terms of spending. Those who don't qualify for SSD or SSI would have to deal with state-level work requirements.

"Now we have this sort of administrative wave, kind of building on whatever momentum you have in public favor to dismantle the program administratively", Callow said in a phone interview. "And cutting off people from Medicaid is certainly not going to improve their health".

"They want to push people off medicaid and... give states... the option to tell people that you can't be on Medicaid because you're not working", Gerisch said.

In Kentucky, which expanded Medicaid, Republican state Sen.

Calling the new policy "unconscionable and illegal", Eliot Fishman, senior health policy director at the liberal consumer health lobby Families USA, said in a statement: "Today's announcement isn't about work". But critics of the historic shift argue that the issue is far more complicated, and that if states do adopt the work requirements, millions of needy people's Medicaid coverage will be disrupted.

A poll from the Kaiser Family Foundation in June showed that fully 70 percent of Americans favored allowing states to impose work requirements on non-disabled adults receiving Medicaid, which is basically what the Trump administration is doing. The Kaiser Family Foundation estimates that there are almost 25 million non-elderly adults on Medicaid who are not on disability insurance. Later, a work requirement found its way into the Supplemental Nutrition Assistance Program, a revamp of what used to be called food stamps. But a closer look reveals that many of those people face obstacles to entering the workforce. Most who are not report reasons such as illness, caring for a family member or attending college.

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In the end, Altman said, the change likely won't have a significant difference given that 59% of Medicaid recipients already work and those that don't are likely in the exempted categories.

The changes would apply to "able-bodied" adults, who are physically and mentally capable of working and not medically frail, the application says.

"The state has little evidence for why the current Gateway to Work program would fare better if mandatory", wrote Jon Laramore, executive director of Indiana Legal Services.

Faced with questions about who will lose coverage under the work enforcement policy, Medicare and Medicaid administrator Seema Verma reportedly said decreased enrollment will come from people finding coverage through their employers. After President Bill Clinton signed welfare reform into law in 1996, the share of families below the poverty line that receive welfare benefits dropped from 68 percent in 1996 to 23 percent in 2016, according to CBPP.

That's why it's important that we expose the argument for work requirements for what it actually is - an attempt to perpetuate myths that stereotype people of color and stigmatize popular public programs that opponents simply don't like.

The proposed Arizona policy change originated with a state law passed in 2015 by legislators who say work requirements incentivize people to gain financial independence from government support and are also critical to maintain Medicaid's viability. But Neale made clear that states are in the "best position to determine which approaches are most likely to succeed".

In its guidance to states, CMS said they should consider how some communities have high unemployment rates and whether enrollees need to care for young children or elderly relatives.

Many Medicaid enrollees may have physical or mental health problems - such as arthritis or asthma - that don't meet the criteria for federal disability programs, but still interfere with their ability to work, Kaiser said.

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