Friday, 19 January, 2018

Kentucky First to Set Medicaid Work Requirements

Kentucky Is First State Ever to Require Medicaid Recipients to Work	 	 	 			Kentucky State Capitol Kentucky Is First State Ever to Require Medicaid Recipients to Work Kentucky State Capitol
Faye Gross | 14 January, 2018, 00:30

"Today's troubling decision by the Centers for Medicare and Medicaid Services will reduce access to basic health care for Kentuckians by imposing unnecessary, bureaucratic restrictions for Medicaid recipients", said Christie Gillespie, President and CEO of PPINK.

Traditionally, Medicaid covered people not able to work - the elderly, children and the disabled.

Additionally, there's not consensus the programs are effective at getting people into jobs, said Joan Alker of Georgetown University during a conversation in Lexington, Kentucky in November. He says that by working, Medicaid beneficiaries will improve their autonomy. Republican Kentucky Governor Matt Bevin sought permission to add work requirements back in the summer of 2016. The Trump administration issued guidance to states Thursday regarding how to impose a Medicaid work requirement. According to Robert Rector, the goal of having people work to get Medicaid is not meant to reduce poverty but is instead to ensure that those who benefit from public programs contribute to them.

Ten states have submitted proposals for Medicaid work requirements so far. The activities include jobs training, community service or education.

Pugel said that sounds good in theory, but the reality would be different. Taking away people's access to health care is a "terrible strategy if you want to promote work".

Copyright 2018 NPR. To see more, visit http://www.npr.org/.

The Trump administration on Wednesday sent a letter to state Medicaid directors announcing a policy to authorize work requirements for states with what are known as "Medicaid 1115 waivers". It's up to states to define that. With this data, money can be handed out to the poor in society, with the aim of bettering their health.

"Working doesn't make people healthy".

NPR health policy correspondent Alison Kodjak is with us now to talk about this.

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"CMS recognizes that a broad range of social, economic, and behavioral factors can have a major impact on an individual's health and wellness, and a growing body of evidence suggests that targeting certain health determinants, including productive work and community engagement, may improve health outcomes", read the letter from Brian Neale, CMS' Medicaid director. According to his own administration, the work requirements will result in 95,000 fewer people on Kentucky's Medicaid rolls.

For instance, the guidance notes that some Medicaid recipients may have trouble meeting these requirements because of poor health, substance abuse or high unemployment in their areas.

The new rule is sweeping and requires providers and suppliers to use an "all-hazards" approach when conducting a risk assessment to develop an emergency plan.

KODJAK: Yeah, and that's true. Most of those who don't work cite illness, disability or family obligations as the reason. States must also create exemptions for people who are "medically frail". And people caring for minor children could be exempted. If recipients don't work, they will also lose eligibility status. They say conservative rationales for them are at best disingenuous and at worst malicious.

KODJAK: Yeah. So actually, 10 states already have applied for these waivers.

CMS told Bevin's office Friday that the agency had approved Kentucky's request and appreciated "the spirit of partnership" between the state and the agency.

MCEVERS: What is in that application?

KODJAK: Well, CMS is asserting that, and they have cited several studies in their guidelines. If they don't comply, they could qualify for coverage for only three months in every three-year period. And opponents are anxious that that's the problem. "What we are doing is providing targeted supports that will help qualified Apple Health clients to maintain housing and jobs-and ultimately self-sufficiency".

MCEVERS: NPR's health policy correspondent Alison Kodjak, thank you so much.

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