The Trump administration has unveiled a major policy shift that offers a path for states seeking to tie Medicaid eligibility to work requirements. It also states explicitly that states can't get federal Medicaid money for services like childcare and transportation that people might need to get back to work.
CMS said in the letter the new guidance allows states to experiment with the idea of work requirements (or related activities such as skills training, education, job search, caregiving, volunteer service) "in order to determine whether those requirements assist beneficiaries in obtaining sustainable employment".
Under federal law, Medicaid waivers have to support the program's objectives by increasing coverage or health outcomes for people on Medicaid.
Ten states - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, Mississippi, New Hampshire, Utah and Wisconsin, are now seeking work requirements for Medicaid recipients.
"The goal of our federal welfare programs should be to give individuals the opportunities they need to succeed and become self-supporting and independent", said Congressman Poliquin.
For people in exceptionally vulnerable positions - say, someone who just lost his job after failing a drug test and can't find an available space at a substance abuse program in his area - adding another bureaucratic hurdle could make it even more hard to get back on track.
Health insurance reforms initiated during Barack Obama's presidency raised the income cap for access to Medicaid, allowing millions of low-income earners to join the Medicaid rolls.
Not only does it have a new Medicaid director, but the state is searching for at least one other company to help manage its privatized system, which has been coming under sharp criticism.
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Many Medicaid recipients are already employed.
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 already work full time or part time. The guidance explicitly states that budget neutrality still applies to 1115 waivers. She said she would attempt to get answers from HSD officials, but did not respond before press time.
"It is stupid because it will actually prevent people from working - with health needs unattended, many low-income people will be unable to seek work".
While more than 74 million people are enrolled in Medicaid, only a small fraction would be affected by the work requirement.
The Trump administration said Thursday that it would get poor people to work by letting state governments deny them Medicaid if they don't have a job. In 2016, a federal judge stopped the state from requiring people to work who receive Supplemental Nutrition Assistance Program (SNAP) benefits because of a long-running federal lawsuit over the state's inability to process aid. About 70 percent of Americans say they support states imposing a work requirement on non-disabled adults, according to a Kaiser Family Foundation poll previous year.
Some conservatives, like the Heritage Foundation's Robert Rector, have also opposed work requirements in the past, arguing people who lose coverage will likely cost the government more via unpaid emergency room bills.
The U.S. Medicaid program has grown by double digits in states like Arizona that expanded Medicaid under the Affordable Care Act.
"Those who qualify for an exemption also must successfully document and verify their exempt status, which could be as often as monthly", she said in an emailed statement.
Many people can have physical or mental health problems - such as arthritis or asthma - that don't meet the criteria for federal disability programs, but still interfere with their ability to work, Kaiser said.