Tuesday, 23 January, 2018

States can make work requirement part of Medicaid

Centers for Medicare and Medicaid Services administrator during her Senate Finance Committee confirmation hearing in Washington on Feb. 16 2017. MUST CREDIT Bloomberg Trump administration allow work requirements in Medicaid
Melissa Porter | 14 January, 2018, 13:26

Requirements could involve forcing recipients to prove they are actively seeking work, volunteer their time to community service if they cannot find work, or undergo job training programs.

"Our policy guidance was in response to states that asked us for the flexibility they need to improve their programs", Verma said in a statement.

Ten states are waiting to impose such requirements, and Kentucky may receive permission to do so as soon as Friday, according to The Washington Post. Its justification: cutting insurance for low-income Americans who don't work will improve their health.

Beneficiaries range from pregnant women and newborns to elderly nursing home residents.

"Those are the people who need Medicaid coverage the most, because the rely on it". Notably, among adults with Medicaid coverage, almost 8 in 10 live in working families and a majority are working themselves.

Federal law gives the secretary of health and human services broad authority to grant waivers for state demonstration projects that "promote the objectives" of the Medicaid program.

MaryBeth Musumeci, associate director for the Kaiser Family Foundation's Program on Medicaid and the Uninsured, said the processes states implement for enrollees to document and verify their compliance could be overly burdensome.

"While work requirements are meant to promote work among those not working, coverage for those who are working could be at risk if beneficiaries face administrative obstacles in verifying their work status or documenting an exemption", KFF said.

So far, 10 states-Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin-have submitted waiver proposals that include "employment and community engagement initiatives", according to CMS.

But he indicated the state has its hands full for now dealing with other Medicaid issues.

Work requirements also are opposed by the Illinois Health and Hospital Association, which advocates for more than 200 hospitals and almost 50 health systems in the state.

Critics worry that kicking people off Medicaid for not having a job will penalize a small number of vulnerable Arizonans, and force them to get care in emergency rooms, which in the end is more costly for the health-care system.

But that's just not how it works, says Mary Gerisch, a member chair of the Rights & Democracy health care justice team. Ron Wyden of OR, the top Democrat on the Senate committee that oversees Medicaid. CMS supports states' efforts to align SNAP or TANF work or work-related requirements.

Federal officials said they would support state efforts to require able-bodied adults to engage in work or other "community engagement activities" as a condition of eligibility for Medicaid.

According to a recent analysis by the nonprofit Kaiser Family Foundation, 6 in 10 of the almost 25 million working-age, nondisabled adults on Medicaid are already working full time or part time. The remaining 60% of non-SSI Medicaid adults who either work part-time or full-time; presumably would meet any work requirement policy.

-Taking into account hardships for people in areas with high unemployment, or for people caring for children or elderly relatives. Alker says that seems like a good thing, though the "cynic" in her worries it's created to keep the question of how many people will lose Medicaid "even more in the dark".

House Speaker Richard Corcoran, R-Land O' Lakes, told The News Service of Florida on Wednesday that the state's $26 billion Medicaid program is comprised mostly of children and seniors and that work requirements are more geared toward able-bodied adults who qualify for Medicaid under the Affordable Care Act, commonly called Obamacare.

Now that the work requirement has been approved, Miller said he expects "quick approval" of the state's proposal he said will help "Medicaid beneficiaries improve their social, educational, and health outcomes". Although waivers can have lasting impact they don't amount to a permanent change in the program.