Trump opens way for Medicaid work requirement

Power outage causes attendees to evacuate Central Hall at CES in Las Vegas on Wednesday Jan. 10th 2018

Power outage causes attendees to evacuate Central Hall at CES in Las Vegas on Wednesday Jan. 10th 2018

In its guidance, CMS pointed to studies that show working and volunteering can contribute to better health as justification that the requirement is in keeping with Medicaid's mission.

Verma said that in travelling the country, she finds that people want to get off Medicaid and get insurance elsewhere.

Before she became the CMS administrator, Verma was a health-care consultant who specialized in helping states redesign their Medicaid programs.

But it's not clear how many people would be affected by the new rules. That center is part of the U.S. Department of Health and Human Services.

Beneficiaries range from pregnant women and newborns to elderly nursing home residents.

More than 70 million Americans depend on Medicaid for health insurance, according to the Kaiser Family Foundation. These are individuals who are physically capable of being actively engaged in their communities, whether it be through working, volunteering, going to school or obtaining job training. States must propose such changes through waivers and receive federal approval.

"States will therefore be required to describe strategies to assist eligible individuals in meeting work and community engagement requirements and to link individuals to additional resources for job training, provided they do not use federal Medicaid funding to finance these services", CMS said.

The 10-page memo accompanying the announcement lays out the details for how states can restructure their programs to include these requirements.

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.

Ten states have asked the agency for flexibility in the Medicaid program, according to Verma. Damon Thayer said work requirements could lessen the program's impact on the state budget. It has also helped people work: Studies of Medicaid expansion in OH and MI found that the majority of beneficiaries said that getting health coverage helped them look for work or remain employed. Ron Wyden of OR, the top Democrat on the Senate committee that oversees Medicaid.

The work requirements will likely have an impact on a broad number of adults. Long rejected racial stereotypes, like the caricature of an "able-bodied" single mother of color "collecting" public benefits and willfully refusing to work while living a lavish lifestyle, have been successfully used to support "reforms" that actually limit eligibility for many programs like Medicaid. Almost 60 percent work either full time or part time, mainly for employers that don't offer health insurance.

Many recipients do not work because of illness (36 percent) or family obligations (30 percent), the study found.

TALLAHASSEE | While the Trump administration signaled willingness this week to allow work requirements for Medicaid beneficiaries, the Florida Legislature is unlikely to move ahead with such a mandate this year.

-Taking into account hardships for people in areas with high employment, or for people caring for children or elderly relatives. That could mean counting time spent in drug treatment as a form of "community engagement".

What is the Trump administration allowing states to do?

Although waivers can have lasting impact they don't amount to a permanent change in the program.

The Trump administration's guidance represents a fundamental and much-disputed recalibration of the compact between the government and poor Americans for whom Medicaid coverage provides a crucial pathway to health care.

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