White House Says States Can Force Medicaid Enrollees to Work

Centers for Medicare & Medicaid Services Administrator Seema Verma

Centers for Medicare & Medicaid Services Administrator Seema Verma

CMS administrator Seema Verma said the changes were made at the request of states seeking to make the 50-year-old health insurance program more responsive and "help people in achieving greater well-being and self-sufficiency". The guidance cites research that it says demonstrates people who work tend to have higher incomes associated with longer life spans, while those who are unemployed are more prone to depression, "poorer general health", and even death.

States seeking waivers must ensure that beneficiaries who live in areas with high unemployment are able to meet work requirements, or at least link them to resource for job training, though they can not use federal Medicaid funds for this goal.

Kaiser polling a year ago found that 70 percent of the public support allowing states to impose work requirements on Medicaid recipients, even as most people in the USA were against deep Medicaid cuts sought by congressional Republicans and the Trump administration.

According to Verma, 10 states so far have submitted applications for federal waivers to impose a work requirement: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

Sometimes, amazingly, I know, politicians do things just because they are heartless, soulless bastards who deserve to be eaten by Denebian slime-devils and then vomited into the fires of Mount Doom. They are among the states awaiting word from CMS on their requests to impose work requirements - efforts that were routinely rejected under the Obama administration when states broached them before.

The governor's office expects more people to transition to private coverage as the project takes root, though in the coming years, enrollment will fluctuate for "a variety of reasons, including program noncompliance".

But Senate Health and Human Services Appropriations Chairwoman Anitere Flores, R-Miami, said the Senate has not discussed requiring those now enrolled in the program to work.

The Trump administration, along with many Republican leaders in Congress, has long supported such a move.

IN is among 10 states with requests pending.

Sixty percent of Medicaid's non-elderly adults already work, according to a recent analysis of census data by the Kaiser Family Foundation.

Advocates for low-income people said work has never been a requirement for Medicaid, a program originally intended as a health program for the poor and disabled.

The Centers for Medicare & Medicaid Services released a guidance Thursday outlining what states need to do to mandate that certain Medicaid enrollees work to qualify for benefits.

The new plan sets the stage for a potentially long and contentious legal battle over the shape and objective of a health program that more than 70 million Americans now depend on.

"States ... want more flexibility to engage their working-age, able-bodied citizens on Medicaid", Verma told a gathering of state Medicaid directors in November. The administration's bid to cut the program under the guise of mobility-enhancing work requirements must be seen for what it is.

Ten states -including IN and Kentucky - have submitted proposals to add a so-called work requirement to their Medicaid plans.

"It's not like Medicaid is providing some kind of alternative lifestyle that's attractive and keeps people out of the workforce", he said. Barring the possibility that they find an employer sympathetic to his or her special needs, the only way to get out of this in-between space is to eventually become sick or disabled enough that they are eligible for Medicaid. They argue that new restrictions and reporting requirements will cause many people to lose Medicaid health coverage.

The federal guidelines do say states should be flexible, noting some may have trouble meeting requirements. They're considered "demonstration programs" to test ideas.

Federal Medicaid officials compared a work requirement to similar conditions 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. By providing coverage for workers in jobs that are unlikely to provide such benefits, and by helping to stabilize the finances of people with illnesses, Medicaid has been found to help people stay employed or find work.

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 or elderly relatives.