Saturday, 22 September, 2018

In major shift, Trump admin. will let states impose Medicaid work requirement

FILE- Gov. Charlie Baker listens as Health and Human Services Secretary Marylou Sudders speaks during a news conference on Tuesday Health Highlights: Jan. 11, 2018
Andrew Cummings | 12 January, 2018, 03:21

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.

Technically, those waivers would be 'demonstration projects.' In practical terms, they would represent new requirements for beneficiaries in those states.

"Among the adult Medicaid enrollees who were not working, most report major impediments to their ability to work including illness or disability or care-giving responsibilities", the study adds.

"A$3 growing body of evidence suggests that targeting certain health determinants, including productive work and community engagement, may improve health outcomes" the letter says.

The new policy guidance sent to states is meant to help them design demonstration projects that promote the objectives of the Medicaid program and are consistent with federal statutory requirements.

At least ten states are considering section 1115 Medicaid waivers that require enrollees to have a job, train for a job or participate in community activities like volunteer work.

Lambeth said he has been puzzled by the Trump administration's slow approach to the state Medicaid waiver request. President Obama expanded the program by allowing states to cover millions more low-income adults. "The most vulnerable people are the ones who need Medicaid coverage the most, and they will lose it", Pavetti said. "Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today's announcement is a step in that direction", CMS Administrator Seema Verma said in a statement. It laid out the basics for work requirements that would be attached to a proposal called "Carolina Cares", a bill with some Republican backing that contemplates a modified version of Medicaid expansion.

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'There's never been a work requirement in Medicaid, it's only been in recent years that states have raised the possibility of having one, ' she said.

It's unclear which states will be the first to pursue a first-of-its-kind Medicaid work requirement waiver. "Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration". Demonstrations, which give states additional flexibility to design and improve their programs, are also created to evaluate state-specific policy approaches and better serve Medicaid populations. "A strong Medicaid program. does more than just provide [beneficiaries] a card".

States would have to build new systems to determine who is subject to work requirements and verify whether beneficiaries fulfilled them, said LaDonna Pavetti, vice president at the Center on Budget and Policy Priorities, a left-leaning think tank.

"It is telling that both the Trump administration and the states proposing work requirements also have proposed major cuts to Medicaid that would take away coverage from millions of people", said Eliot Fishman, senior director of health policy of Families USA. That's because children - who make up almost half of Medicaid enrollees - are excluded.

Almost eight in 10 adults in Medicaid are already in working families, and most are working themselves, according to the Kaiser Family Foundation. In addition to traditional work and job training, engagement could include caring for a child or elderly parent, seeking treatment for drug addiction or going to school.

The Obama administration would have never approved such waivers, she added.

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