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Trump opens path for states to seek work requirements for Medicaid

Trump opens path for states to seek work requirements for Medicaid

Ten states, including ME and New Hampshire, had sent proposals to the federal government seeking the controversial change.

"Our policy guidance was in response to states that asked us for the flexibility they need to improve their programs and to help people in achieving greater well-being and self-sufficiency", Seema Verma, the administrator of the Centers for Medicare and Medicaid Services (CMS), said in a statement.

The waivers with work requirements will still see heavy political pushback, and there will probably be legal challenges.

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 work requirements "could have negative implications on many who are working or exempt from the requirements".

Verma stressed that the administration is providing an option for states to require work, not making it mandatory across the country.

Ten states - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin - have already filed applications with CMS to add work requirements to their Medicaid programs.

"The governor believes that Medicaid is an important safety net for many Iowans, and her hope is that those on the program who are able-bodied are able to find a career and re-enter the workforce", Smith said in an email.

'Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries'.

CMS administrator Seema Verma called it "incentivizing community engagement" in a tweet sent out shortly after the new guidelines were released.

People with a disability, pregnant women, elderly people, children, and the "medically frail" must also be exempted from the requirement, according to the new rule.




Cobey Culton, spokesman for N.C. Department of Health and Human Services, said the department is "reviewing the new guidance to understand how it may impact us".

"This action by the Trump administration goes after people who are just trying to get by", Democratic U.S. Senator Ron Wyden of OR said.

LaDonna Pavetti, vice president for family income support policy at the Center for Budget and Policy Priorities, said in a recent blog post the evidence "shows that work requirements won't move people out of poverty and eliminate their need for health coverage".

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.

A study from the non-partisan Kaiser Family Foundation found that nearly 60% of working-age adults on Medicaid are already employed.

Most who are not working report reasons such as illness, caring for a family member or going to school. Demonstrations, which give states additional flexibility to design and improve their programs, are also created to evaluate state-specific policy approaches and better serve Medicaid populations.

The debate about work requirements doesn't break neatly along liberal-conservative lines.

CMS also encourages states to consider a range of activities that could satisfy work and community engagement requirements.

States must also fully comply with federal disability and civil rights laws and ensure that all individuals with disabilities have the necessary protections to ensure that they are not inappropriately denied coverage. "Each state is different", the letter says, and such activities "include, but are not limited to, community service, caregiving, education, job training, and substance use disorder treatment".

But Democrats and many advocates are pushing back on the guidance, arguing people will lose coverage if they don't meet the requirements or the requirements will lead some not to apply because the process may become too cumbersome.


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