Gov. Reynolds is 'reviewing' Trump administration guidance on Medicaid work requirements

Erika Holt
January 14, 2018

The much-anticipated move - which was condemned by patient advocates, physicians and consumer groups - would mark the first time in the program's half-century history that the government will require able-bodied people to work in exchange for health coverage. "If you look at our Medicaid population, mostly children, mostly seniors, and single pregnant moms, I don't think that is necessarily something that we would do".

And people in Medicaid are often dealing with crises - they may move a lot, or change phone numbers, making them hard to track down.

But Senate Health and Human Services Appropriations Chairwoman Anitere Flores, R-Miami, said the Senate has not discussed requiring those now enrolled in the program to work.

On March 14, 2017, the Department of Health and Human Services and CMS issued a letter to the nation's governors affirming the federal government's partnership with states to improve the integrity and effectiveness of the Medicaid program for low-income people with Medicaid.

Arizona, New Hampshire, Kansas, Arkansas, Indiana, Utah, Kentucky, Maine, North Carolina and Wisconsin submitted proposals asking to run demonstrations evaluating the use of job training, education, volunteer opportunities and other activities as requirements for Medicaid beneficiaries.

Vanita Gupta, president and CEO of The Leadership Conference on Civil and Human Rights, said, "Imposing a work requirement to be eligible for Medicaid not only fails to further the goal of providing healthcare, but also undermines the underlying objective".

The Medicaid program was started 52 years ago.

"As a result, these state-specific comments fall far short of the type of public notice and comment that typically attaches to such a significant about face", Jane Perkins, NHeLP's legal director, writes.

The Obama administration stretched the guidelines for Medicaid coverage to allow millions of working adults to qualify for the program. Verma said she issued the guidance in response to requests from states wanting to "improve their programs and to help people in achieving greater well-being and self-sufficiency".

For close to a year, the administration has signaled an interest in helping states that want to institute work requirements.

Screen Shot 2018 01 11
The Kaiser Family Foundation

The administration's latest action seeks to allow states to apply the rules in such a way that would allow them to impose work requirements on "able-bodied" adults.

"This is creating an impediment to people who might've lost their job and in fact need help getting work, not an extra requirement that keeps them from getting the needed medical care that keeps them healthy", he said.

Critics worry that kicking people off Medicaid for not having a job will penalize a small number of vulnerable Arizonans, and force them to get care in emergency rooms, which in the end is more costly for the health-care system.

"Imposing work requirements on Medicaid recipients is counterproductive and most likely illegal", said Cedric L. Richmond, the representative from Louisiana, adding that people on Medicaid who can work are already working.

About 40 percent of nonelderly, non-disabled adults who have Medicaid coverage aren't working, according to an analysis from the Kaiser Family Foundation.

Has Pennsylvania considered a work requirement? Individuals would be also be exempt if a medical professional determines they're medically frail or have an acute condition preventing them from working.

But congressional Democrats and advocates said the Trump administration is moving in the wrong direction.

Moreover, given the bleak prospect for meaningful health care legislation at the federal level in 2018, Trump's willingness to allow states the flexibility to do their own reform is a promising development. More than a third of those 25 million Americans say they are ill or disabled, and 30 percent say they're taking care of "home or family".

A large majority of Medicaid recipients - nearly two-thirds - are children, elderly or disabled. The guidance also says that states should also consider "caregiving for young children or elderly family members". Under state work requirements, people have to verify their work status or their qualification for an exemption, according to MaryBeth Musumeci, associate director of Kaiser Family Foundation's Program on Medicaid & the Uninsured.

In addition to work or volunteer requirements, Bevin's plan includes copayments and premiums from many participants.

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