New Hampshire has become the fourth state to receive federal approval for an Affordable Care Act waiver to require able-bodied adults to work, get job skills or perform community service to receive benefits under Medicaid expansion.
Kentucky, Indiana and Arkansas have also received ACA waivers for work requirements under policies adopted by the Trump Administration in November.
New Hampshire received waiver approval on May 7, authorizing the state to require able-bodied adults ages 19-64 to participate in 100 hours per month in employment, education, job skills training or community service community as a condition of premium assistance program benefits.
The state first adopted Medicaid expansion in 2014 and approved amendments for charging low income and medically frail beneficiaries different levels of cost sharing and copayments.
In comments received by the Department of Health and Human Services about the state waiver, concerns were raised about whether the proposal met the objectives of Medicaid, according to a letter from the agency to Henry D. Lipman, Medicaid director for the New Hampshire Department of HHS. The Centers for Medicare and Medicaid Services believes that's because community engagement can be positively correlated with health outcomes, and furthers the purposes of the Medicaid statute to test and evaluate whether these requirements improve beneficiaries' health and promote beneficiary independence, the letter said.
Verma congratulated New Hampshire Governor Chris Sununu and said, "The Trump Administration has helped create one of the strongest job markets in our nation's history and we want to make sure able-bodied, working age adults receive the necessary skills to join our growing workforce."
Many Democratic leaders oppose the work requirement as undermining access to healthcare. The waivers will result in fewer people enrolled in Medicaid.
Kentucky projected earlier this year that its waiver would save the state and federal governments $2.2 billion over five years. The state projects a 15 percent drop in adult Medicaid enrollment by the fifth year, according to the Center on Budget and Policy Priorities.
Medicaid expansion, a program of the ACA, extended the health insurance program to low income individuals who were formerly not eligible for Medicaid.
Republicans, who were making attempts at entitlement reform, said Medicaid was never meant to be a health insurance program for a large population.
In November 2017, Verma unveiled the new Medicaid policies to encourage states to take advantage of Section 1115 demonstration waivers to get able-bodied citizens back to work.
Waivers also exist for drug screening and testing requirements, eligibility time limits, benefit restrictions including copays and engagement in healthy behaviors and enhanced behavioral health services including substance use disorders, among others.
New Hampshire Governor Chris Sununu said, "Work requirements help lift able-bodied individuals out of poverty by empowering them with the dignity of work and self-reliability while also allowing states to control the costs of their Medicaid programs."