Trump Administration Says States May Impose Work Requirements for Medicaid

By ROBERT PEAR | JAN. 11, 2018

Advocates for Medicaid beneficiaries said the new policy was likely to be challenged in court if people were denied coverage for failure to meet a state’s work requirement.

WASHINGTON — The Trump administration said on Thursday that it would allow states to impose work requirements in Medicaid, a major policy shift that moves toward fulfilling a conservative vision for one of the nation’s largest social insurance programs for low-income people. 

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

“Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today’s announcement is a step in that direction,” said Seema Verma, the administrator of the federal Centers for Medicare and Medicaid Services.

Ms. Verma said the Trump administration was responding to requests from Medicaid officials in 10 states that wanted to run demonstration projects testing requirements for work or other types of community engagement like training, education, job search, volunteer activities and caregiving.

Under the new policy, Trump administration officials would allow work requirements in Medicaid somewhat similar to those already imposed in other programs like food stamps, now known as the Supplemental Nutrition Assistance Program, and the welfare program known as Temporary Assistance for Needy Families.

In a speech to state Medicaid officials in November, Ms. Verma indicated that the Trump administration would be receptive to work requirements and other conservative policy ideas to reshape Medicaid. And she criticized the Obama administration, saying it had focused on increasing Medicaid enrollment rather than helping people move out of poverty and into jobs.

“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,” Ms. Verma said. “Those days are over.”

The Medicaid proposals came from Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. Several other states are considering work requirements.

In one state, Kentucky, the waiver application seeks to require most non-disabled Medicaid beneficiaries age 19 to 64 to work at least 20 hours a week. They could meet the requirement through not just paid employment, but also volunteer work, job training, searching for a job, going to school or taking care of someone elderly or disabled.

Pregnant women, full-time students and primary caretakers of children under 19 or disabled adult dependents would be exempt from the state’s work requirement, as would people deemed medically frail.

Advocates for Medicaid beneficiaries said the new policy was likely to be challenged in court if people were denied coverage for failure to meet a state’s work requirement.

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. In the past, federal officials said that work was not among those objectives. . .

“Productive work and community engagement may improve health outcomes,” Brian Neale, the director of the federal Medicaid office, said on Thursday in a letter to state Medicaid directors. “For example, higher earnings are positively correlated with longer life span.”

In addition, Mr. Neale said, researchers have found “strong evidence that unemployment is generally harmful to health,” while employment tends to improve “general mental health.”

Medicaid beneficiaries could work at a variety of jobs — as cashiers, telemarketers, housekeepers, nursing and home health aides, child care providers, cooks and dishwashers, waiters and waitresses, retail sales clerks, landscapers, security guards and construction laborers, for example. They could also work as volunteers at food pantries and other charitable organizations. . .

Read the entire report at https://www.nytimes.com/2018/01/11/us/politics/medicaid-work-requirements.html?rref=collection%2Fbyline%2Fabby-goodnough&action=click&contentCollection=undefined&region=stream&module=stream_unit&version=latest&contentPlacement=7&pgtype=collection

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