Kentucky First State Approved for Medicaid Work Requirements
13 January 2018, 05:29 | Erica Roy
Medicaid's chief federal officer is Seema Verma; her home state of IN submitted plans for a work requirement previous year, and the approval letter could come any day now. The agency is expected to start approving state waivers promoting "community engagement activities" in coming weeks.
Kentucky's plan is certain to face a legal challenge, with advocates arguing that changes contemplated by the state's plan are not allowed under federal Medicaid law, including work requirements, the elimination of transportation services to medical appointments and monthly premiums charged to people in poverty.
The legislature passed a law in 2017 stating that the program will not be renewed this time around, unless a work requirement is authorized.
Seema Verma, the administrator of CMS, has lauded the new guidance as a step forward for Medicaid and public health.
It's a "large and sharp reversal" from Medicaid in the past, says Judith Solomon, vice president of health policy at the Center on Budget and Policy Priorities.
In addition to the large group of enrollees already working, the federal guidelines excluded children - who make up almost half of Medicaid enrollees.
"Productive work and community engagement may improve health outcomes", Brian Neale, the director of the federal Medicaid office, said Thursday in a letter to state Medicaid directors.
"Should eligible Medicaid recipients be looking for work or be trying to work?"
Putnam said the federal match would be replaced in part by higher spending from private insurers because of a greater number of people on employer-sponsored plans.
Expanding access to health care would help alleviate the opioid crisis and create 15,000 jobs in hospitals and clinics, the center said.
One Bevin staffer suggested that the state's Medicaid rolls will be reduced by roughly 95,000 within the next five years because of the work requirements. CMS said states would have to test whether the work requirement improves enrollees' health - a point Solomon ridiculed.
Bevin's work requirement is aimed largely at "able-bodied" adults added to Medicaid under the Affordable Care Act and would exclude the elderly, disabled, medically frail, pregnant women or some adults caring for children or other relatives. Bevin said he expects the program to be fully implemented at the beginning of next year. "It's giving them a pathway to improved quality of life, expanded opportunities and an increased sense of worth", he said.
"The truth is, people are going to lose Medicaid coverage", he said.
The requirement, modeled after the work requirement for the state's food stamps program, would initially apply to enrollees ages 30-49 and would then be extended to those ages 19-29.
Federal and state officials and health policy experts said Medicaid beneficiaries could work at a variety of jobs - as cashiers, telemarketers, housekeepers, nursing and home health aides, child care providers, cooks and dishwashers, waiters and waitresses, retail sales clerks, landscapers, security guards and construction laborers, for example.
Failure to pay a premium after a 60-day grace period would result in them losing coverage and being unable to enroll again for six months unless all past due and current premiums and the beneficiary completes a "state-approved health literacy or financial literacy course". Among those Medicaid recipients who aren't working, most reported that a major illness, disability or family caregiving responsibility prevented them from working.
If proponents of work requirements are serious about helping people find work, they would invest in skill training and workforce development programs, rather than increasing red tape and making it harder for people to access health care.
"Today's attack on Medicaid is just the latest salvo of the Trump Administration's 2018 war on health care", Brad Woodhouse, director of the pro-ObamaCare group Protect Our Care, said in a statement.
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