Tuesday, 19 June, 2018

Want Medicaid? Get a job, Trump administration says

Seema Verma Centers for Medicare and Medicaid Services administrator during her Senate Finance Committee confirmation hearing in Washington on Feb. 16 2017 Health Highlights: Jan. 11, 2018
Faye Gross | 12 January, 2018, 03:20

Health and Human Services Secretary Marylou Sudders said such a requirement has "not been something we've been pursuing" and indicated she likely won't seek to add it amid other efforts to reshape the state's Medicaid program, known as MassHealth.

"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.

Technically, those waivers would be 'demonstration projects.' In practical terms, they would represent new requirements for beneficiaries in those states.

The major policy shift seeks to overhaul the long-standing social contract between state and federal governments and poor citizens who rely on their services.

Steve Wagner with the Universal Health Care Action Network says there are many reasons why Medicaid beneficiaries may be unemployed, but being unmotivated is not at the top of the list.

The state and federal comment periods have closed for at least seven states that have already asked CMS to allow them to institute work requirements, according to NHeLP.

This would be the first time in the 52-year history of the Medicaid program that there is any sort of work requirement.

Other states to receive approval are Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, Utah and Wisconsin.

The Obama administration stretched the guidelines for Medicaid coverage to allow millions of working adults to qualify for the program.

It now covers a broad cross-section of people, from many newborns to elderly nursing home residents, and increasingly working adults.

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In a statement released this afternoon, Baker's office said it "does not support applying work requirements to the MassHealth program".

CMS Administrator Seema Verma said in her letter that employment and higher earnings are associated with improved mental health and overall wellbeing. "Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration".

In the end, Altman said, the change likely won't have a significant difference given that 59% of Medicaid recipients already work and those that don't are likely in the exempted categories.

Certain Medicaid populations would be exempt from the rules, including those with disabilities, the elderly, children, and pregnant women. Adding a work requirement will only add additional bureaucracy and unnecessary administrative hurdles that will result in fewer people having health care.

As of October 2017, almost 75m individuals were enrolled in Medicaid and the children's health insurance program (Chip).

The changes are an opening salvo in the administration's push this year to overhaul federal safety net programs, with the White House asking departments and agencies across the government to review eligibility for low-income assistance programs.

According to the Kaiser Family Foundation, 40 percent of Medicaid recipients nationwide, or 9.8 million, do not work, while 42 percent work full time and 18 percent work part time. Of those without a job, more than a third are ill or disabled, 30 percent are caring for young children, and 15 percent are in school, the analysis shows.

But it makes suggestions for states as to what counts as work, including state work programs, job training, volunteering, or caring for a relative.

Under Kentucky's waiver application, for instance, people on Medicaid would be required to report income changes within 10 days, noted Cara Stewart of the Kentucky Equal Justice Center.

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