Door opens to link work, Medicaid

Ceria Alfonso
Enero 14, 2018

It's unclear which states will be the first to pursue a first-of-its-kind Medicaid work requirement waiver.

For states that have their waivers approved, they will then be required to track and evaluate the outcomes related to their demonstration programs, said Brian Neale, deputy administrator and director for the Center for Medicaid and CHIP Services. President Obama expanded the program by allowing states to cover millions more low-income adults.

Several experts noted that threatening to strip coverage from poor people who are not working is inconsistent with the program's legal mission to improve health and therefore could be subject to challenge in court.

The agency is encouraging states to align their Medicaid work requirements with those mandated by other federal safety net programs.

The Trump administration says any work requirements would only apply to "able-bodied" adults, with exemptions for children, the elderly and people with disabilities.

American College of Physicians (ACP) president Jack Ende, MD, said the result of this new policy will be restricting Medicaid eligibility in a statement opposing work requirements.

Many patient advocates note that a small fraction of the people covered by Medicaid are of working age, nondisabled and now unemployed. Two-thirds of Illinois' non-disabled and non-elderly Medicaid recipients hold a full-time or part-time job, and more than 80 percent are part of working families, according to the Kaiser Family Foundation's analysis of 2016 Census data. According to the study, the majority who were not working said they were ill, caring for a family member, or attending a school.

The document details who should be excluded from the new work requirements — including children and people being treated for opioid abuse — and offers suggestions as to what counts as “work.” Besides employment, it can include job training, volunteering or caring for a close relative.

Verma, who served as a Medicaid consultant for IN and Kentucky before joining the Trump administration, has long advocated for work requirements.

It found that almost half of them already work, and that 11 percent were unable to work.

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Critics of the Trump administration's approach note that a growing body of evidence shows that Medicaid health coverage is helping many Americans improve their health and their finances, not holding them back, as Verma and other have suggested. The Obama administration repeatedly rejected states' requests to do so, saying it wasn't consistent with Medicaid's goal to provide access to medical care. The new policy allows states to make exceptions to the work rules for caregivers and students, but it doesn't require that they do so.

A University of MI team recently published data in JAMA Internal Medicine from detailed survey of more than 4,000 MI residents enrolled in the state's expanded Medicaid program.

"There are strong reasons to believe that work requirements will reduce access to health care and thereby make it harder for some people to work", said Hannah Katch, a policy analyst at the liberal-leaning Center on Budget and Policy Priorities.

The proposed Arizona policy change originated with a state law passed in 2015 by legislators who say work requirements incentivize people to gain financial independence from government support and are also critical to maintain Medicaid's viability.

"There are a lot of different ideas, and a lot of ways to go about this", Verma said.

A recent University of MI study found that about one quarter of Medicaid recipients were able to work but unemployed.

Democrats in Congress and liberal-leaning groups which have supported the Affordable Care Act were quick to criticize the concept of work requirements. Sen.

But it's not clear how many people would be affected by the new rules.

This will be the first work requirement in Medicaid's 52-year history.

Hager said the lack of a work requirement in New Mexico's proposal is a good thing for residents.

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