Trump to Allow States to Require Medicaid Beneficiaries to Work

Health Highlights: Jan. 11, 2018

States can require Medicaid recipients to work for benefits under new Trump policy

The Trump administration announced Thursday that it will open the door for states to impose work requirements for Medicaid recipients, in a major shift that could affect millions of low-income people receiving benefits.

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

The Trump administration has signaled from the outset that it wanted to set a more conservative tone for Medicaid, a 1960s-era program that was part of Lyndon Johnson's anti-poverty Great Society.

Ten states - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, Mississippi, New Hampshire, Utah and Wisconsin, are now seeking work requirements for Medicaid recipients. This would exclude individuals eligible for Medicaid due to a disability, elderly beneficiaries, children, and pregnant women. According to the Kaiser Family Foundation, which is a nonpartisan research organization that focuses on health care, almost 60 percent of Medicaid recipients work either full time or part time, with the majority of the unemployed recipients citing reasons such as illness, attending school or caring for family members. States that opted out of Medicaid expansion had higher rates of uninsured persons and hospitals were six times more likely to close.

The move is expected to impact millions of Americans who rely on the state-federal program to help get health coverage.

"There's never been a work requirement in Medicaid, it's only been in recent years that states have raised the possibility of having one", she said. Verma also said states would have to make "reasonable modifications" for those battling opioid addiction and other substance-use disorders.

Such regulations are already in place for most recipients of Supplemental Nutrition Assistance Program, commonly known as food stamps.

"In a time of heated debate and division, helping Americans at or near the poverty line improve their lives and no longer need public assistance should be a cause that unites us all", Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said Wednesday in a conference call previewing the move.

About 40 percent of nonelderly, non-disabled adults who have Medicaid coverage aren't working, according to an analysis from the Kaiser Family Foundation. Most who are not report reasons such as illness, caring for a family member or attending college.

Ten states are at present applying to force work necessities in Medicaid. "We want to give states as much flexibility as possible because that's where we'll be able to evaluate what actually works best". States should ensure that career planning, job training, referral, and volunteering opportunities considered to meet the community engagement requirement, and job support services offered in connection with the requirement, take into account people's employability and potential contributions to the labor market.

CMS declined to say how many people could be potentially impacted by the work requirements, saying it would depend how states designed the programs.

Verma also had a major role in designing an unorthodox approach to Medicaid in IN, which had asked the Obama administration to approve a work requirement. In practical terms, they would represent new requirements for beneficiaries in those states.

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