Trump Allows States To Add Medicaid Work Requirement

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Thousands of poor adults in Kentucky will have to find jobs and pay monthly premiums to retain their Medicaid coverage as a result of drastic changes to the state's health insurance program approved Friday by the Trump administration. It's a big change from the Obama administration, which rejected overtures from states that wanted to add a work requirement.

Take Arizona, one of the 10 states that have applied for federal approval for a work requirement.

An HHS official, who spoke on the condition of anonymity because the official had not been authorized to discuss the developments, said the agency may approve Kentucky's request as early as Friday.

"Infusing the requirement into our eligibility requirements acts as a nice incentive for enrollees in their effort to seek out employment and job training", she said.

"Kentucky is leading the nation in this reform in ways that are already replicated by well over a dozen states and growing", he said.

The federal government will let states implement a work requirement for certain medicaid recipients.

"I applaud CMS and Governor Bevin for recognizing the unaffordable mess left behind by his predecessor and responding with innovative, common-sense steps to engage patients, improve health, and reduce the burden on Kentucky taxpayers", he said. Reuters noted that decision to allow work requirements faces probable legal challenges.

The debate about work requirements doesn't break neatly along liberal-conservative lines.

A detailed evaluation of Medicaid expansion in OH by that state's Department of Medicaid explains how it pays off for workers and taxpayers.

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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.

Verma, who has said she doesn't think Medicaid should become a way of life for people who are not disabled, said the new guidance shows how the administration is trying to give states more flexibility in running Medicaid.

A study from the nonpartisan Kaiser Family Foundation found that a surprising number of working-age adults on Medicaid are already employed. Medicaid expansion is exactly that type of policy.

Democrats and health advocacy groups blasted the federal policy on Thursday, saying it would make it tougher for the most vulnerable Americans to have access to healthcare.

Enrollees who will be exempt from this include full-time students, former foster care youth, pregnant women, people with an acute medical condition and primary caregivers. Besides employment, it can include job training, volunteering or caring for a close relative.

The stated objective of the new guidance is to encourage work, which the Trump administration argues is ultimately good for people's health. Pregnant women and children will be exempt from that cost sharing. It allowed states to provide coverage to anyone earning up to 138 percent of the federal poverty level (about $16,600 for an individual). "Medicaid is a health program that is supposed to serve people who don't otherwise have coverage".

Some Democratic-leaning states are not expected to make the change.

Kentucky was one of the 32 states that expanded Medicaid, the health insurance program traditionally covering children, the elderly and disabled, under the Affordable Care Act. And the proportion of doctors taking at least as many Medicaid as privately insured patients climbed nearly 6 percentage points to about 56 percent.

"It's going to make administration a lot more complicated, and it's going to create a lot more red tape", said Robyn Merrill from Maine Equal Justice Partners. About 52 million of the 74 million Medicaid enrollees rely on managed-care companies for their coverage.

Kaiser Health News (KHN) is a national health policy news service.

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