Trump Administration Says States May Make Medicaid Recipients Work to Get Benefits

Power outage causes attendees to evacuate Central Hall at CES in Las Vegas on Wednesday Jan. 10th 2018

The Trump administration told USA states on Thursday they can for the first time move toward imposing work or job training requirements on people as a condition for obtaining health insurance under the Medicaid government program for the poor.

The elderly, disabled, children and pregnant women would be excluded from the requirements. Besides employment, it can include job training, volunteering or caring for a close relative.

The National Health Law Program (NHeLP) is pressing the Centers for Medicare and Medicaid Services (CMS) to give the public more time to comment on state proposals to impose work requirements in the Medicaid program.

The new policy comes as 10 states are already lined up, waiting for federal permission to impose work requirements on able-bodied adults in the program. It is likely to prompt a lawsuit from patient advocacy groups, which claim the requirement is inconsistent with Medicaid's objectives and would require an act of Congress.

The historic move would be a significant change in how the government health insurance program operates and would fulfill a longtime Republican goal. But administration officials argue that the work requirements will strengthen the program and improve health outcomes by encouraging Americans to train for and seek out jobs.

ME now has a proposal pending that would require able-bodied adults to be working, training for a new career, or volunteering. South Dakota's governor said in his State of the State address Tuesday that he would also look to require certain recipients to work.

The state's request is still pending with federal Medicaid regulators, but the Trump Administration's announcement indicates such a request would be approved. Damon Thayer said work requirements could lessen the program's impact on the state budget. The ACA allowed states to expand eligibility to low-income adults without children, with the federal government covering most of the cost.

The Trump administration has signaled from the outset that it wanted to set a more conservative tone for Medicaid, a 1960s-era program that was part of Lyndon Johnson's anti-poverty Great Society.

"Among the adult Medicaid enrollees who were not working, most report major impediments to their ability to work including illness or disability or care-giving responsibilities", the study adds.

But work requirements have strong public backing. Adding a work requirement will only add additional bureaucracy and unnecessary administrative hurdles that will result in fewer people having health care.

"I have personally talked to the Trump administration and asked for an expedited review, and I get full assurances we will get their full priority", Lambeth said.

"For those who can not find work, requiring unpaid volunteer work in exchange for health coverage is unconscionable legally and morally, recalling the days of work houses for the poor".

In its guidance to states, CMS said they should consider how some communities have high unemployment rates and whether enrollees need to care for young children and elderly families. She said the federal government is expected to begin approving state plans for work requirements in "short order".

In a letter sent to State Medicaid Directors, Brian Neale, director of the Centers for Medicare and Medicaid Service, said the changes are created to promote "better mental, physical and emotional" health of recipients.

"Medicaid needs to be more flexible so that states can best address the needs of this population", she said in a statement.

Verma, who worked with Kentucky and IN on their work requirement waivers as a health consultant before joining the Trump administration, recused herself from the decision on those states' waiver requests.

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