ibusinesslines.com March 21, 2018

Robert Weissman: Medicaid Work Requirements: Cruel, Stupid and Illegal

14 January 2018, 03:18 | Charlene Valdez

Adam Berry Getty Images

Adam Berry  Getty Images

Donald Trump's administration moved Thursday to let states require that able-bodied adults work in order to receive health care benefits through Medicaid, a pillar of the USA social safety net.

New Hampshire is one of ten states that has submitted a work requirement waiver to the Centers for Medicare and Medicaid Services.

More than 1.2 million non-disabled working-age adults receive Medicaid in IL, and most do work. "But the more sinister motive is to further create the stigma of being poor for people who are having employment and health problems and to further divide our country so that instead of looking at each other as human beings, who all have a right to health care, we look at each other as deadbeats". 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. Don't be fooled. It's the first of several expected steps to shrink and weaken the Affordable Care Act's Medicaid expansion that provided coverage for 11 million low-income adults, with incomes up to 138% of the federal poverty line.

"Medicaid needs to be more flexible so that states can best address the needs of this population", Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said in a statement. Many Republicans opposed the enlargement of Medicaid eligibility authorized under Obamacare.

Of Medicaid enrollees who didn't work in 2016, 36 percent were ill or disabled, 9 percent were retired, 30 percent were caretakers, 15 percent were going to school, 6 percent could not find work and 3 percent were in an other category, according to a December Kaiser Family Foundation report. And another state may soon be added to that list, as South Dakota Gov. Dennis Daugaard said Tuesday that he's asked the state's Department of Social Services to pursue a Medicaid work-requirement waiver.

The work requirements will likely have an impact on a broad number of adults. They are among the states awaiting word from CMS on their requests to impose work requirements - efforts that were routinely rejected under the Obama administration when states broached them before. Her agency spelled out safeguards that states should put in place to get federal approval for their waivers. She said she would attempt to get answers from HSD officials, but did not respond before press time.

Bevin's proposal would require some adults to work or volunteer at least 20 hours a week to keep health benefits, saying it will inject more personal responsibility into the government health plan and believes participants should have some "skin in the game".

The new policy guidance sent to states is meant to help them design demonstration projects that promote the objectives of the Medicaid program and are consistent with federal statutory requirements. The new policy allows states to make exceptions to the work rules for caregivers and students, but it doesn't require that they do so.

Such rules, never before approved by the federal government, are a key part of Bevin's plan to reshape Medicaid in Kentucky.

Pregnant women, children, the elderly and those in drug treatment would be excused.

Advocacy groups said most Medicaid recipients already have jobs, and those who do not may have difficulty accessing transportation to get to and from work or need to care for family members.

"The guidance was just released and we will assess accordingly as we do with any guidance, however the administration does not support applying work requirements to the MassHealth program", said Baker spokesman Brendan C. Moss.

According to the Kaiser Family Foundation, Medicaid covers 20 percent of Americans, and 6 in 10 able-bodied adults now enrolled in Medicaid work full or part-time.

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