New Medicaid guidelines could require recipients to work for benefits

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Medicaid is a federal-state collaboration covering more than 70 million people, or about one in five Americans, and that makes it the largest government health insurance program.

The Centers for Medicare and Medicaid Services has issued a new rule that makes it possible for states to require Medicaid recipients to work, or undergo job training, in order to receive benefits.

Kaiser polling previous year found that 70 percent of the public support allowing states to impose work requirements on Medicaid recipients, even as most people in the USA were against deep Medicaid cuts sought by congressional Republicans and the Trump administration.

CMS said the work and community engagement policy is for working-age, non-pregnant Medicaid beneficiaries who are not eligible for Medicaid on the basis of a disability.

In those states that receive a waiver for the work requirements, those now working will be required to provide documentation that they are working, and those who are not will be required to prove that they should be exempted.

"Work requirements impose an additional, unnecessary barrier to allowing patients access to vital health care services for people who need access and coverage the most".

States seeking waivers must ensure that beneficiaries who live in areas with high unemployment are able to meet work requirements, or at least link them to resource for job training, though they can not use federal Medicaid funds for this goal.

To be approved for a waiver, states have to show that their plan is revenue neutral.

The Medicaid program was started 52 years ago.

Under the proposed work requirement, people will have to prove that they're working or performing some other qualifying activity such as volunteering.

Several experts noted that threatening to strip coverage from poor people who are not working is inconsistent with the program's legal mission to improve health and therefore could be subject to challenge in court.

And as Kaiser's Drew Altman wrote in April, it's unlikely that the change will affect that many Medicaid beneficiaries, because such requirements usually have key exemptions for family care, the disabled and those of retirement age. 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.

That's not to say that work requirements are a bad idea for Medicaid.

Trump's popularity is already an issue in the race, and now his Medicaid work-rule decision could become a campaign issue as Republicans criticize Wolf's record. "Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today's announcement is a step in that direction", said Seema Verma, the agency's administrator. States will be required to offer reasonable modifications to individuals with disabilities, and will be required to exempt individuals determined to be medically frail or who have an acute condition that a medical professional has determined will prevent them from complying with the requirements.

The new policy would be attempting to solve a problem that doesn't exist.

Also protected would be Medicaid enrollees who are too ill to work, especially because of a drug addiction.

"So I think you take those recommendations, embed it in, put it back on the Governor's desk and let him explain to taxpayers why people who are capable of working are not working", said Rep. Seth Grove, (R) - York County. An increase in the access requirements, no matter what those requirements entail, will necessarily reduce the number of people who are able to access Medicaid.

Wisconsin is among 10 states seeking work requirements for Medicaid recipients.

The National Association of Medicaid Directors, a nonpartisan group representing state officials, said in a statement there's no consensus on whether work requirements are the right approach. "Productive work and community engagement may improve health outcomes". Additionally, the guidance details that states can not accrue savings from loss in enrollment due to work requirements, which means that states will need to pay for any work requirement administrative burden, such as determining if an individual is working, developing an enrollee reporting system and employment supportive services, etc.

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