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Trump Administration posts new policy guidance: If Americans want Medicaid, they have to work

The Centers for Medicare and Medicaid Services said the new policy released on Thursday is for working-age, non-pregnant beneficiaries.

Susan Morse, Senior Editor

The Trump Administration on Thursday released new work requirements for able-bodied beneficiaries to receive Medicaid.

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.

[Also: CMS head Seema Verma will sit out vote on Kentucky's Medicaid work mandate]

CMS Administrator Seema Verma outlined the new policy in a January 11 letter to state Medicaid directors. 

Ten states have asked the agency for flexibility in the Medicaid program, according to Verma. The demonstration projects will be done by Section 1115 Medicaid waivers as under current law, states cannot impose a work requirement as a condition of Medicaid eligibility.

[Also: Seema Verma promises CMS is focusing on interoperability, patient empowerment]

CMS said the work and community engagement policy is for working-age, non-pregnant Medicaid beneficiaries who are not eligible for Medicaid on the basis of a disability. 

How the new policy affects providers is so far unknown. Currently, more than one-third of doctors won't see Medicaid patients, according to Verma.

Medicaid covers about half of the babies born in this country, she said. 

Verma does not specifically state that those who don't work will be cut off from Medicaid coverage, but Twitter Thursday lit up with accusations of cutting off "frail" enrollees while others applauded the initiative to get people "on the dole" back to work.

Vanita Gupta, president and CEO of The Leadership Conference on Civil and Human Rights, said, "Imposing a work requirement to be eligible for Medicaid not only fails to further the purpose of providing healthcare, but also undermines the underlying objective. Notably, among adults with Medicaid coverage, nearly 8 in 10 live in working families and a majority are working themselves. Adding a work requirement will only add additional bureaucracy and unnecessary administrative hurdles that will result in fewer people having healthcare."

CMS did not directly address Medicaid expansion, which has been adopted by 31 states and the District of Columbia.

The new policy requires states to assist beneficiaries in meeting work and community requirements in child care assistance, transportation and other support, but said states will not have the authority to use the Medicaid funding to finance these services.

Meeting work and community engagement requirements should take into consideration areas of high unemployment or caregiving for young children or elderly family members, CMS said. 

"States will therefore be required to describe strategies to assist eligible individuals in meeting work and community engagement requirements and to link individuals to additional resources for job training, provided they do not use federal Medicaid funding to finance these services," CMS said.

Of Medicaid enrollees who didn't work in 2016, 36 percent were ill or disabled, 9 percent were retired, 30 percent were caretakers, 15 percent were going to school, 6 percent could not find work and 3 percent were in an other category, according to a December Kaiser Family Foundation report.

CMS said it would support state efforts to align Medicaid work and community engagement requirements with Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families (SNAP and TANF).    

States will be required to offer reasonable modifications to individuals with disabilities and will be required to exempt individuals determined to be medically frail or who have an acute condition that a medical professional has determined will prevent them from complying with the requirements, CMS said.

CMS will also require states to make reasonable modifications for individuals with opioid addiction and other substance use disorders. 

The agency said it is encouraging states to consider a range of activities that could satisfy work and community engagement requirements. States should ensure that career planning, job training, referral, and volunteering opportunities are considered to meet the community engagement and job requirement, and that people's employability and potential contributions to the labor market should be factors taken into account.

"States have the opportunity to help individuals improve and enhance the skills that employers truly value," Verma said. "People who participate in activities that increase their education and training are more likely to find sustainable employment, have higher earnings, a better quality of life, and, studies have shown, improved health outcomes."

In an address to Medicaid directors in November, Verma said that with Medicaid being an open-ended entitlement, the program and spending have grown. In 1985, Medicaid spending consumed less than 10 percent of state budgets and totaled just over $33 billion. In 2016 that number had grown to 29 percent of total state spending at a total cost of $558 billion.

Despite increased scrutiny and regulation, the rolls have expanded yet Medicaid is not doing its job to care for vulnerable populations, she said.

CMS has created a state Medicaid and CHIP scorecard to demonstrate state progress.

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