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Trump White House clears path for Medicaid work requirement

January 14, 2018 02:54·
Adam Berry Getty Images

Adam Berry Getty Images

Although the announcement says states must protect people who can't meet a work requirement because of illness or disability, don't hold your breath.

The Trump administration is opening the door for states that want to seek work requirements for Medicaid recipients.

Medicaid, unlike cash welfare payments, isn't a disincentive to work, because it doesn't provide people with funds they'd need to pay rent or buy food, said Jeff Grogger, an urban policy professor at the University of Chicago. However, booting people from Medicaid-because they can't find work, can't document it, or can't justify to the authorities that they are unable to work-in no way guarantees "they don't need the program".

Courts have said states can't add additional requirements for Medicaid eligibility that are not in law, a coalition of groups.

Opponents said the administration had it backwards, saying healthier people are able to work, not that working people are healthier. States will be required to offer reasonable modifications to individuals with disabilities, and will be required to exempt individuals determined to be medically frail or who have an acute condition that a medical professional has determined will prevent them from complying with the requirements.

Advocates say the work requirement and other changes will cause up to 95,000 Kentuckians to lose health coverage, according to the administration's own calculations. Medicaid is a means-based program, meaning that only low-income people (the income cut-off varies by state) will be affected by these changes.

The new plan sets the stage for a potentially long and contentious legal battle over the shape and objective of a health program that more than 70 million Americans now depend on.

The Trump administration has announced its decision to allow states to impose work requirements on residents receiving Medicaid.

Republicans said Mr. Trump's stance is a much-needed reversal that will return the program's focus to the truly needy, while steadying federal and state budgets.

First, it would reduce the taxpayer burden of administering the program through voluntary attrition of those who refuse to work.

Thursday's announcement wasn't a huge surprise.

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The Centers for Medicare and Medicaid Services (CMMS) issued guidance making it easier for states to design and propose test programs that implement such requirements.

In a letter to state Medicaid directors, the White House is signaling a willingness to approve state requests to require people seeking health coverage through the Medicaid program to have a job or participate in other approved forms of "community engagement".

CMS Administrator Seema Verma said 10 states have submitted demonstration project proposals: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

But critics of work requirements say they contradict the core goal of Medicaid, which is to help low-income people access medical benefits, and could end up making it even harder for people to land jobs if they end up being sicker.

But that's just not how it works, says Mary Gerisch, a member chair of the Rights & Democracy health care justice team. States should ensure that career planning, job training, referral, and volunteering opportunities are considered to meet the community engagement and job requirement, and that people's employability and potential contributions to the labor market should be factors taken into account. For instance, time spent in medical treatment may count toward community engagement time, while those in intensive treatment may be exempt. The rules can't apply to people who are disabled.

Another Kaiser study found that most working-age adults on Medicaid are already employed.

Among adult non-elderly Medicaid enrollees who do not work, most report major impediments to their ability to find a job, according to KFF. CMS has used that to conclude that work requirements will improve health outcomes, even if they lead to people losing their health insurance.

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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.

"I think there would be a ton of opposition", Hager said. "They just said there are considerations...."

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