Some states will impose work requirements for Medicaid

Frederick Owens
January 13, 2018

"We're ready to show America how this can and will be done".

Bevin noted in a news conference Friday that Kentucky's is the first waiver with a community engagement requirement approved.

Before coming to Washington past year, Verma was a health consultant who worked with IN and Kentucky to expand Medicaid under the ACA.

"It will be a model for the nation", he said.

Kentucky Education and Workforce Cabinet Secretary Hal Heiner said the new program will also help the state's workforce issues by putting citizens in need on a path to better health and financial stability.

"During the campaign, Bevin pledged to end Kentucky's highly successful Medicaid expansion, but as governor, he did not have the courage to do it", the congressman said.

The changes are aimed at decreasing what the state will have to pay to run the program, which was expanded to cover many more people under the Affordable Care Act.

Bevin's Medicaid proposal, officially submitted to the federal government in August 2016, requires some adults to work or volunteer at least 20 hours a week to keep health benefits, along with many other changes to the Medicaid program in the state. The policy change should help people find jobs that offer health coverage or make enough money to afford private plans, she said. Or, as he said on Friday, the waiver will give enrollees "the dignity associated with being able to earn the things they are receiving".

Bevin agreed the plan might face a legal challenge but seemed unconcerned.

Lawsuits are expected as individual states roll out work requirements. Kevin de León, a Democrat and the leader of California's Senate, wouldn't comment on the proposal because he said it's a non-starter.

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But it makes suggestions for states as to what counts as work, including state work programs, job training, volunteering, or caring for a relative.

Dustin Pugel, policy analyst with the Kentucky Center for Economic Policy, said Friday the change will reverse "the historic progress" Kentucky made in health care over the past two years. "It's not about employment encouragement".

Ultimately, the most obvious effect from imposing work requirements in Medicaid will be to deprive more people of the health coverage they need to live healthy, productive lives.

Those who don't meet the requirements or don't provide adequate documentation will lose coverage. More than 60 percent of the non-working Medicaid recipients were women, according to Kaiser; 17 percent were parents with children under age 6. The letter released Thursday by CMS authorizing work requirements contains similar language.

While more than 74 million people are enrolled in Medicaid, only a small fraction would be affected by the work requirement.

The Obama administration turned down several state requests to add a work requirement.

"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. "These radical and counterproductive changes will result in almost 100,000 Kentuckians losing coverage".

The Health and Human Services Department outlined how states could reshape the program in a directive.

"They're going to try to force a square peg into a round hole", he said.

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 is the first state to win such approval. "We look forward to reviewing the outcomes from Kentucky's thoughtfully-crafted, groundbreaking demonstration, which will undoubtedly aid Medicaid reform efforts across our nation". Providers and advocates in Kentucky immediately blasted the waiver approval. States must propose such changes through waivers and receive federal approval.

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