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New Guidelines on Medicaid Work Requirements

New Guidelines on Medicaid Work Requirements

In a letter to state Medicaid directors Thursday morning, the Trump administration announced that it would allow states to require Medicaid recipients to participate in a work program or other form of approved "community engagement" in order to retain their health benefits. Many of their employers, however, don't offer healthcare coverage. CMS is blocking states from using any savings derived from cutting off people's Medicaid to achieve revenue neutrality.

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. The guidance marked a major policy shift in the joint federal-state health program for low-income and disabled Americans. "As our letter explains, the administration is making an about face in its efforts to overturn established [Department of Health and Human Services] policy against work requirements without public comment".

Besides Wisconsin, the other states that have applied for waivers involving work requirements or community involvement are: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina and Utah.

Medicaid recipients commonly work in agriculture, construction, leisure and hospitality and retail - some 40% of enrollees are in these industries. Other requested changes include requiring Medicaid recipients to undergo drug screening and seek treatment if they test positive.

Pallone said that "the Trump administration's action today is cruel and a clear violation of both the Medicaid statute and longstanding congressional intent" for waivers that were meant to "allow states to expand access to Medicaid, not restrict it".

In an address to Medicaid directors in November, Verma said that with Medicaid being an open-ended entitlement, the program and spending have grown. However, if states align their work requirements with existing systems, such as those used with TANF and SNAP, it could decrease administrative costs. And even if the standard for Medicaid work-requirement exemption is much more lenient than the standard for social security, it still grants the state a mechanism requiring people to fight for coverage they should be entitled to. Medicaid is pretty different from even other government health care programs; its beneficiaries are the poorest people in America, kids, and people with disabilities-a coalition of Americans who often have the most hard health care needs in the country compared with the employer-sponsored private health market.

"The other thing [that was mentioned was] that people are less depressed when they have money, well yeah, people that are on Medicaid are frequently depressed, I would imagine so", the activist said.

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According to a recent analysis by the nonprofit Kaiser Family Foundation, 6 in 10 of the almost 25 million working-age, nondisabled adults on Medicaid are already working full time or part time.

Soon, the administration will likely approve "waiver" proposals, starting with Kentucky and IN and followed by other states, to end Medicaid coverage not only for people who aren't working, but also for those who didn't pay premiums - or renew their coverage - on time. The work requirements added in 1996's welfare reform came from Congress working together on a bipartisan statute with a president who badly needed some centrist wins.

Together, these data indicate that hundreds of thousands of able-bodied Nevadans receive Medicaid coverage without having to work. These requirements would not apply to elderly Medicaid recipients, children, pregnant women, or those whose benefits were due to a disability.

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

Calling the new policy "unconscionable and illegal", Eliot Fishman, senior health policy director at the liberal consumer health lobby Families USA, said in a statement: "Today's announcement isn't about work".

In addition, federal officials said, providing care for young children or elderly family members can sometimes qualify as work. "Conservatives who favor work requirements see Medicaid coverage as another form of government welfare benefit, like cash assistance, requiring reciprocal obligations from beneficiaries, and a disincentive to work". In the end, that state included in its Medicaid expansion only an encouragement of voluntary efforts by beneficiaries to train for work or find jobs.


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