Trump Administration Opens Door For Medicaid Work Requirements

WASHINGTON, DC — A major policy shift announced Thursday by the Trump administration would give states a path to cut off Medicaid benefits to recipients if they aren’t working or volunteering in their communities. The federal-state safety net program, approved in 1965, provides government health insurance for about 70 million low-income Americans.

The Medicaid program, the government’s largest health insurance program, was vastly expanded under the Obama administration and now provides coverage to about 1 in 5 Americans. States sought exemptions, but were sharply rebuffed. There has never in the past been a requirement that Medicaid recipients hold jobs, and the new policies are likely to face strong political opposition.

Joan Alker, the executive director of Georgetown University Center for Children and Families, told Patch the new rules are “counter-productive and mean-spirited" and is bound to end up in the courts.

“This is an unprecedented and radical step that will lead to low income parents and other adults losing health coverage,” Alker said. “Medicaid helps people find work, and if you take away their medical insurance and they’re not able to address their chronic conditions, they’re less likely to find work.”

Alker pointed out that some of the states seeking work requirements never expanded Medicaid under the Obama administration. Allowing them to restrict eligibility hurts "families living in the deepest poverty," she said.

About a dozen states are seeking waivers to test new ideas for Medicaid recipients, including Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. Alabama, Idaho and South Dakota are considering waiver requests. Kentucky’s request could be approved as early as Friday.

CMS said it its letter outlining Medicaid work requirements that states should consider continuing coverage for certain groups, including pregnant women, disabled people and the elderly. They also should be mindful of safeguarding people who are caregivers for children and the elderly, and those whose Medicaid benefits pay for substance abuse treatment, the CMS said in its guidance to states.

CMS said the changes will result in better health outcomes and increased engagement in communities. One of those "positive outcomes" is moving people off public assistance and into jobs that provide health insurance, said CMS head Seema Verma.

An analysis by the Kaiser Family Foundation shows that most Medicaid recipients already work, but the majority of those who don't have a health condition that prevents them from getting a job. Among Medicaid recipients who don't have jobs, 36 percent are ill or disabled, 30 percent are caregivers, 15 percent are student, 9 percent are retired, 6 percent couldn't find jobs and 3 percent list other reasons, according to the Kaiser research.

Alker and other health policy experts are skeptical the policy shift will result in positive change, as CMS promises.

Judy Solomon of the Center on Budget and Policy Priorities told Patch she doubts the new policy will improve health outcomes, as the CMS says it will, but will actually worsen it for people who lose the critical care they need to remain healthy.

“This is likely to hurt a lot of people beyond the people they say are targeting,” Solomon said.

She called the arguments advanced in support of state waivers amount to "trying to come up with the rationale to justify a very sharp reversal of policies."

States seeking waivers are going beyond imposing wok requirements, Solomon said.

For example, a waiver request in Kentucky is likely to not only require recipients to work, but also impose other conditions, like cutting off recipients if they don’t pay premiums toward their insurance, which would Solomon said would result in decreased participation, or if they miss paperwork deadlines or fail to report small changes in income.

“What states are doing is undermining the expansion of Medicaid after multiple attempts to repeal the expansion failed,” Solomon said. “This is very much is part of an effort that failed legislatively.”

The debate about work requirements doesn't break neatly along liberal-conservative lines. Polling last year by the nonpartisan Kaiser Family Foundation found that 70 percent of the public support allowing states to impose work requirements on Medicaid recipients, even as most people in the United Stats were against deep Medicaid cuts sought by congressional Republicans and the Trump administration.

The Associated Press contributed to this report.

President Donald Trump and Administrator of the Centers for Medicare and Medicaid Services Seema Verma (AP Photo/Evan Vucci, File)