Medicaid patient: 'If I could work, I would'

Seema Verma

States will now be able to impose work requirements on able-bodied, low-income American adults to receive Medicaid benefits, the Trump administration signaled Thursday.

"Subject to the full federal review process, CMS (the federal Centers for Medicare & Medicaid Services) will support state efforts to test incentives that make participation in work or other community engagement a requirement for continued Medicaid eligibility or coverage for certain adult Medicaid beneficiaries in demonstration projects authorized under section 1115 of the Social Security Act", the letter said. States should try to align their Medicaid work requirements with similar conditions in other programs, such as food stamps and cash assistance. Individuals eligible for Medicaid due to a disability, elderly beneficiaries, children and pregnant women would be excluded from any work or community engagement requirements, according to CMS, and the guidance also calls for "reasonable modifications for individuals with opioid addiction and other substance use disorders".

States seeking waivers must ensure that beneficiaries who live in areas with high unemployment are able to meet work requirements, or at least link them to resource for job training, though they can not use federal Medicaid funds for this objective. "We see people moving off of Medicaid as a good outcome", Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, told reporters on today (Jan. 11).

A Medicaid expert at Manatt Health who advises states on their program design said Verma's announcement reverses long-standing federal policy.

More than 1.2 million non-disabled working-age adults receive Medicaid in IL, and most do work. States would have to come up with a program and submit it to Washington in order to receive a waiver. "As Medicaid has expanded to able-bodied individuals, the needs of this population are even more imperative".

This will be the first work requirement in Medicaid's 52-year history. Yet the Centers for Medicare & Medicaid Services will likely soon allow Kentucky and IN to charge premiums to poor adults and cut off their coverage or charge them more to get care if they don't pay - and to cut them off if they're not working. It also found large decreases in the share of people struggling to pay medical bills and relying on hospital emergency rooms for care.

Why is the Trump administration talking about a work requirement?

LaDonna Pavetti, a vice president at the left-leaning Center on Budget and Policy Priorities, argues that none of the studies CMS' cites suggest that work requirements improve public health.

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Steve Wagner with the Universal Health Care Action Network says there are many reasons why Medicaid beneficiaries may be unemployed, but being unmotivated is not at the top of the list.

"Carolina Cares enrollees would be required to be employed or engaged in activities to promote employment", the state's waiver request states. This disagreement with expansion lies at the heart of the decision to allow states to make Medicaid changes that the states themselves admit will reduce coverage.

But according to Callow with Families USA, the new policy might not sustain court challenges. People whose income allows them to be eligible for Medicaid nearly certainly can not afford these upfront costs.

“We believe that the work requirement is indeed a problem because it is not consistent with Medicaids objectives” to furnish medical assistance, she said. The Trump administration is making it easier for states to make coverage contingent on new criteria, such as having a job. By that time their health care will be much more expensive to the state (if they survive that long).

Sometimes, amazingly, I know, politicians do things just because they are heartless, soulless bastards who deserve to be eaten by Denebian slime-devils and then vomited into the fires of Mount Doom. Additionally, the guidance details that states can not accrue savings from loss in enrollment due to work requirements, which means that states will need to pay for any work requirement administrative burden, such as determining if an individual is working, developing an enrollee reporting system and employment supportive services, etc.

The Kaiser Family Foundation has found hat approximately 40% of non-SSI Medicaid adults are not working, and these individuals are most likely to be affected by this policy.

This nation created Medicaid to help these very people.

Among adult non-elderly Medicaid enrollees who do not work, most report major impediments to their ability to find a job, according to KFF.

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