States wouldn't be able to request work requirements for disabled people and children under the new guidance; however, a number of nonpartisan health care think tanks point out that many Americans who rely on Medicaid can not work because they are the primary care providers for much sicker family members or live with other socioeconomic realities that make finding work more hard.
The Trump administration has taken a major step in allowing states to impose work requirements on Medicaid recipients for the first time. Expansion was a key part of the Affordable Care Act, the idea being it would extend the federal- and state-financed program to the working poor - people who make too much money to qualify for Medicaid but don't get insurance through work or make enough money to qualify for federally subsidized insurance plans through the online exchanges set up under the ACA, often called "Obamacare".
The Centers for Medicare and Medicaid Services issued guidance to support state efforts in requiring work or community involvement in demonstration projects such as skills training, education, job search, volunteering and caregiving.
And yet, Seema Verma, administrator of the Centers for Medicare and Medicaid Services, is touting work requirements as a way to enable individuals covered by Medicaid to "break the chains of poverty" and "live up to their highest potential".
In those states that receive a waiver for the work requirements, those now working will be required to provide documentation that they are working, and those who are not will be required to prove that they should be exempted.
"Liberals find Medicaid work requirements repugnant because they believe that Medicaid beneficiaries want to work if they can, and that providing health coverage to people who cannot afford it is an obligation of any moral nation", Altman wrote.
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The administration is nonetheless expected to quickly approve requests from as many as 10 states, all but one of which has a Republican governor. In November, Ms. Verma told states to start thinking about ways to get the Medicaid population into jobs. "A study examining Michigan's Medicaid expansion found that almost seven in 10 enrollees who were working said they performed better at work once they got Medicaid coverage".
The state and federal comment periods have closed for at least seven states that have already asked CMS to allow them to institute work requirements, according to NHeLP.
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.
Today in Nevada, there are more than 600,000 people - about 20 percent of the state's residents - enrolled in Medicaid at an annual per-capita cost of about $5,700.
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Verma also had a major role in designing an unorthodox approach to Medicaid in IN, which had asked the Obama administration to approve a work requirement.
Verma, who served as a Medicaid consultant for IN and Kentucky before joining the Trump administration, has long advocated for work requirements.
"And most of those who aren't are children, the handicapped, people like that", Garcia said. For decades, Americans have overwhelmingly supported work requirements for government assistance.
"My only hope is that the chaos caused by this policy and the desperation of the Kentucky families who will soon lose their only access to health coverage will force Gov. Bevin to demonstrate some level of compassion and reverse this disgraceful policy", Yarmuth said.
In addition, federal officials said, providing care for young children or elderly family members can sometimes qualify as work.
This cynical claim is based on the bogus assumption that imposing work requirements will magically result in the creation of jobs with health care benefits.
And people in Medicaid are often dealing with crises - they may move a lot, or change phone numbers, making them hard to track down.
In states that now choose to link Medicaid to work, the requirement would apply only to able-bodied adults as defined by each state.
She praised the move as one of freeing up flexibility for states, which Republicans say is sorely needed in the health-care system.
The National Association of Medicaid Directors, a nonpartisan group representing state officials, said in a statement there's no consensus on whether work requirements are the right approach.