Trump administration unveils Medicaid changes, promotes work requirements for coverage

President Trump opens the way for Medicaid work requirement

The Trump organization on Thursday revealed direction enabling states out of the blue to force work necessities in Medicaid, a noteworthy move in the medical coverage program for poor people.

Seema Verma, the overseer of the Centers for Medicare and Medicaid Services, says the move will enable individuals to achieve "independence".

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.

A new Trump administration policy will allow states to screen for "able-bodied" adults who are recipients of Medicaid and impose work requirements on them. Those ten states, Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin, all have Republican executives. It would not apply to those getting benefits due to a "disability, elderly beneficiaries, children, and pregnant women". "While high-quality health care is important for an individual's health and well-being, there are many other determinants of health". States that opted out of Medicaid expansion had higher rates of uninsured persons and hospitals were six times more likely to close.

The Obama administration opposed state efforts to implement work requirements in Medicaid because it could result in fewer people having health insurance.

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Solomon, the advocate for low-income people, said the federal government's waiver authority doesn't provide carte blanche to ignore the basic purposes of the program, and promoting work has not been on that list up to now.

States will likewise be required to portray systems to enable Medicaid beneficiaries to look for some kind of employment, for example, work preparing. "Each state is different", the letter says, and such activities "include, but are not limited to, community service, caregiving, education, job training, and substance use disorder treatment". Programs like the Temporary Assistance for Needy Families, which provides cash assistance to persons with modest incomes, and the Supplemental Nutrition Assistance Program, or food stamps, make work conditional of federal assistance.

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

Recipients who aren't working were mostly taking care of a relative, attending school or too sick. That could mean counting time spent in drug treatment as a form of "community engagement".

The CMS guidance gives states a great deal of flexibility to define their own exceptions to a work requirement, as well as what counts toward work. She was an architect of Kentucky's waiver application once a Democratic governor who had eagerly embraced the ACA was succeeded by Matt Bevin, a Republican who campaigned on a pledge to reverse the program expansion there. For close to a year, the administration has signaled an interest in helping states that want to institute work requirements. States will be required to offer reasonable modifications to individuals with disabilities, and will be required to exempt individuals determined to be medically frail or who have an acute condition that a medical professional has determined will prevent them from complying with the requirements.

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