Trump Administration wants to enforce work requirements for Medicaid

The Trump administration is giving states more flexibility to require Medicaid recipients to work

President Donald Trump listens to Seema Verma, administrator of the Centers for Medicare and Medicaid Service, during a healthcare panel in the Roosevelt Room at the White House on March 22, 2017.

The Trump administration's announcement on Thursday allowing states to tie low-income people's eligibility for Medicaid to work or work-related activities isn't aimed primarily at promoting work.

“Whether it is a job, training, volunteering, substance abuse treatment, additional education or another opportunity, becoming an active and productive member of the community is an important part of healthy living, ” she said in a statement. "Those days are over".

The Obama administration turned down several state requests to add a work requirement.

In new guidelines released by the Trump Administration, states including New Hampshire will now be allowed to impose work requirements on some recipients of Medicaid.

People are not legally required to hold a job to be on Medicaid, but states traditionally can seek federal waivers to test new ideas for the program. In the past, federal officials said that work was not among those objectives. The memo cites studies indicating higher earnings are tied to longer lifespans, whereas unemployment is tied to higher mortality rates.

Most Medicaid beneficiaries who can work, do work. Medicaid enrollees will probably have to go through a new process of demonstrating that they are meeting the work or "community engagement" standards.

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, it said, states can not use federal Medicaid funds to pay for such "supportive services".

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The Medicaid expansion isn't just a "hollow victory of numbers" of people covered, as Verma claims. Many of these sectors often don't offer employees health insurance.

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. That could mean counting time spent in drug treatment as a form of "community engagement".

While more than 74 million people are enrolled in Medicaid, only a small fraction would be affected by the work requirement.

The Times did note, however, that "the Trump administration said that state Medicaid officials could not impose work requirements on pregnant women, elderly beneficiaries, children or people who were unable to work because of a disability". Those who are deemed "medically frail" or have an acute condition that prevents them from working are also exempt.

Kentucky Medicaid Commissioner Stephen Miller said Thursday the decision by federal authorities is key to winning final approval for the Bevin's proposal known as Helping to Engage and Achieve Long Term Health, or Kentucky HEALTH.

A poll previous year from the nonpartisan Kaiser Family Foundation found that 70 percent of the public supported allowing states to require Medicaid recipients to work, even as most Americans opposed deep Medicaid cuts sought by congressional Republicans and the Trump administration.

Callow says the new policy will especially affect those who fall into a gray area of disability - those who don't get Medicaid disability benefits, but are still too sick to work. Consumer advocates and health policy experts fear that such a requirement could prove a big hurdle for many recipients, leaving them without the care they need.

"We know the upshot is people are going to be cut off", said Jane Perkins, legal director of the National Health Law Program, a patient advocacy group that is preparing to challenge the work requirements in court.

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