Trump administration allows states to make Medicaid recipients work

States could require non-disabled, working age recipients to work, volunteer, go to school or enter a job training program.

Posted: Jan 11, 2018 8:31 AM

(CNN Money) -- The Trump administration will allow states for the first time to impose work requirements on Medicaid recipients.

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 agency is expected to start approving state waivers promoting "community engagement activities" in coming weeks.

The historic move would be a significant change in how the government health insurance program operates and would fulfill a longtime Republican goal. States, for instance, could require non-disabled, working age recipients to work, volunteer, go to school or enter a job training program. The guidance also includes caregiving as one of the activities.

"Medicaid needs to be more flexible so that states can best address the needs of this population. 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 agency's administrator.

Critics, however, argue that Republicans are using work requirements to thin the Medicaid rolls. They fear many recipients will be unable to meet the mandate and be left uninsured.

The agency provides states will a lot of flexibility in designing their programs and highlights that many recipients may need additional considerations.

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. States should take these issues -- as well as recipients' employability -- into consideration and allow for modifications or exemptions, the agency said. Pregnant women will also be exempt.

The agency specifically calls out the opioid epidemic, saying that time spent in treatment can count towards the mandate and those in intensive recovery programs can be excused. Many governors, including Republican ones, have defended the Medicaid program as being critical to addressing the substance abuse crisis.

States will be required to describe strategies to assist recipients in meeting the requirements and to link them to job training and support resources, including child care and transportation. However, they will not be allowed to use federal Medicaid funding to finance these services.

The agency is encouraging states to align their Medicaid work requirements with those mandated by other federal safety net programs. Recipients who meet the work requirements in the Supplemental Nutrition Assistance Program, commonly known as food stamps, and by the Temporary Assistance for Needy Families, must be considered in compliance with their state's Medicaid rules.

Republicans have long wanted to add work requirements to the Medicaid program, which covers nearly 75 million low-income children, adults, elderly and disabled Americans. The broadening of Medicaid to low-income adults under Obamacare -- roughly 11 million have gained coverage under the health reform law's Medicaid expansion provision -- further spurred GOP efforts.

However, the Obama administration did not approve any state waivers that would impose work mandates, saying it was not in keeping with the program's mission to provide access to medical services. Consumer advocates and health policy experts fear that such a requirement could prove a big hurdle for many recipients, leaving them without the care they need.

The Trump administration swiftly signaled that it held a different view. Verma, sent a letter to governors soon after she was confirmed in March urging them to apply for such waivers.

Related: Trump administration open to making some Medicaid recipients work, pay premiums

"One of the things that states have told us time and time again is that they want more flexibility to engage their working-age, able-bodied citizens on Medicaid," Verma told a conference of state Medicaid directors in November. "They want to develop programs that will help them break the chains of poverty and live up to their fullest potential. We support this."

The guidance release Thursday pointed to several studies that said unemployment is harmful to one's health and can prompt higher rates of hospital admission and death, as well as poorer general and mental health.

Ten states -- Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin -- have submitted waivers that include work or community engagement requirements, according to the agency. South Dakota's governor said in his State of the State address Tuesday that he would also look to require certain recipients to work.

Verma, who served as a Medicaid consultant for Indiana and Kentucky before joining the Trump administration, has long advocated for work requirements. Now, she is in a position to approve them.

"For the future of our country, we need all Americans to be active participants in their communities," she said in November. "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. Those days are over."

Related: Millions of Medicaid recipients already work

Many Medicaid recipients are already employed. Some 60% of non-disabled, working-age adults have jobs, while nearly 80% live in families with at least one member in the labor force, according to a Kaiser Family Foundation analysis. Most of those who don't work cite illness, disability or family obligations as the reason.

Many Medicaid enrollees may have physical or mental health problems -- such as arthritis or asthma -- that don't meet the criteria for federal disability programs, but still interfere with their ability to work, Kaiser said. Also, some could find it difficult to meet their state's work verification requirements.

"Eligible people could end up losing coverage because the right documentation does not get sent to the right place," said MaryBeth Musumeci, associate director of Kaiser's Program on Medicaid and the Uninsured.

The-CNN-Wire
™ & © 2018 Cable News Network, Inc., a Time Warner Company. All rights reserved.

Huntsville
Clear
76° wxIcon
Hi: 88° Lo: 73°
Feels Like: 76°
Florence
Clear
78° wxIcon
Hi: 93° Lo: 73°
Feels Like: 81°
Fayetteville
Scattered Clouds
73° wxIcon
Hi: 83° Lo: 71°
Feels Like: 73°
Decatur
Clear
74° wxIcon
Hi: 93° Lo: 71°
Feels Like: 74°
Scottsboro
Overcast
73° wxIcon
Hi: 92° Lo: 74°
Feels Like: 73°
WAAY Radar
WAAY WAAY-TV Cam
WAAY Temperatures

Alabama Coronavirus Cases

Confirmed Cases: 99926

Reported Deaths: 1781
CountyConfirmedDeaths
Jefferson13258244
Mobile10517207
Montgomery6835149
Madison544734
Tuscaloosa423076
Baldwin365125
Unassigned363064
Shelby330936
Marshall318937
Lee270047
Morgan241118
Etowah216232
DeKalb183013
Calhoun180717
Elmore173138
Walker153964
Houston141912
Russell13872
St. Clair135418
Limestone134913
Dallas133123
Franklin128820
Cullman122712
Colbert120716
Lauderdale118919
Autauga117421
Escambia108717
Talladega104814
Jackson10144
Tallapoosa86579
Chambers84438
Dale83525
Clarke82610
Blount8124
Chilton8097
Butler76736
Coffee7646
Covington73720
Pike7087
Marion58026
Barbour5765
Lowndes57324
Marengo56515
Hale47826
Bullock46611
Winston45711
Perry4454
Washington44312
Bibb4425
Wilcox43210
Monroe4215
Pickens4049
Randolph40310
Conecuh39310
Sumter36418
Lawrence3512
Macon33914
Crenshaw3265
Choctaw28712
Cherokee2758
Henry2643
Clay2635
Geneva2631
Greene25211
Lamar2292
Fayette2125
Cleburne1271
Coosa1033
Out of AL00

Tennessee Coronavirus Cases

Confirmed Cases: 123914

Reported Deaths: 1233
CountyConfirmedDeaths
Shelby23485308
Davidson20722217
Rutherford658955
Hamilton622053
Knox468540
Williamson357725
Sumner344972
Unassigned31424
Out of TN294714
Wilson232123
Bradley195613
Montgomery195213
Sevier18947
Putnam178518
Trousdale15836
Robertson156720
Hamblen140514
Blount131411
Washington12772
Maury12727
Tipton121110
Madison116018
Sullivan103714
Hardeman93017
Bedford92811
Macon86013
Lake7920
Loudon7493
Gibson7266
Bledsoe7081
Fayette7028
Dickson6982
Anderson6936
Dyer6638
Henderson6043
Cheatham5997
Jefferson5844
Obion5794
Lawrence5756
McMinn55320
Coffee5483
Rhea5382
Warren5334
Carter5246
Lauderdale5148
Haywood5106
Greene5048
Roane4852
Hawkins4837
Hardin4828
Cocke4783
Weakley4634
Cumberland4586
Smith4554
Monroe4529
Giles38513
McNairy3815
DeKalb3652
Franklin3324
Carroll3253
Lincoln3091
Marshall3044
White2945
Henry2900
Johnson2850
Claiborne2760
Hickman2730
Crockett2695
Campbell2541
Wayne2282
Marion2274
Chester2232
Decatur2163
Polk2073
Grainger2000
Overton1981
Unicoi1690
Union1620
Benton1591
Cannon1510
Jackson1291
Humphreys1283
Morgan1261
Scott1220
Grundy1142
Meigs1060
Sequatchie1060
Fentress960
Hancock812
Perry810
Clay780
Stewart780
Lewis741
Moore610
Houston590
Pickett371
Van Buren360

Community Events