Trump administration allows states to make Medicaid recipients work

Hannah Rogers
January 12, 2018

Announcement of the new guidance delivers on the commitment made by Administrator Verma in her address to state Medicaid directors last November, to "turn the page" in the Medicaid program and give states more freedom to design innovative programs that achieve positive results for the people they serve and to remove bureaucratic barriers that block states from achieving this goal.

New Hampshire is one of 10 states seeking a waiver from the federal government to add a work requirement for Medicaid recipients.

About 75 percent of people on Medicaid in Colorado do work, and the remaining people are mostly disabled or caregivers for children or relatives who would have to jump through new hoops with a work requirement to get the care they need.

For instance, Kentucky a year ago proposed work requirements for able-bodied adults to get Medicaid insurance as well as new fees for all members based on income. The link between government help and work later was extended to anti-hunger efforts through the Supplemental Nutrition Assistance Program, as food stamps are now called.

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.

But she said a work requirement hasn't been on her radar "because I've been completely focused on restructuring the Medicaid program and making it sustainable for MA".

"People who participate in activities that increase their education and training are more likely to find sustainable employment, have higher earnings [and] a better quality of life", Verma said.

"Most people have something to contribute to their community through either work or volunteering, and people who can contribute should do so", LePage said.

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When pressed for the president's personal reaction, Gidley said he had not spoken to Trump on that topic specifically. In a statement, Trump said Bannon has nothing to do with his presidency and has " lost his mind ".

Cuello said the argument that work promotes health is "totally contorted".

Sixty percent of Medicaid's non-elderly adults already work, according to a recent analysis of census data by the Kaiser Family Foundation. Verma also said states would have to make "reasonable modifications" for those battling opioid addiction and other substance-use disorders.

"If I can keep getting medical care, I am sure I can go back to being a productive member of society", she said. "We must re-establish Medicaid's core mission of supporting the elderly, disabled and children".

In the states that adopt such requirements, critics say, the effect will spread far beyond the healthy adults who do not already comply.

For instance, the guidance notes that some Medicaid recipients may have trouble meeting these requirements because of poor health, substance abuse or high unemployment in their areas.

The Trump administration is paving the way for one of the biggest policy changes to USA health care in decades. 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. The guidance also includes caregiving as one of the activities. "Although the details on Maine's waiver request still must be worked out, this decision by CMS is a critical first step".

Asked whether Gov. Kim Reynolds might pursue a work requirement, a spokesperson, Brenna Smith, said Thursday that "the governor is reviewing and considering the guidelines that just came out today".

The new regulations' supporters argue that it's a common sense idea.

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