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Likely to Come Soon From the Trump Administration: Guidelines for Medicaid Work Requirements

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Experts speculate that Kentucky could be the first state to see its work requirement waiver approved—a move that could mean 95,000 fewer enrollees in that state over the next five years.

The Trump administration is reportedly preparing to release new guidelines that could pave the way for states to require some Medicaid beneficiaries to work, according to sources who shared information regarding the plans with The Hill. The move would constitute a landmark shift in the 50-year old federal program. And it’s a change that has long been on many conservatives’ wish list of federal health and human services reforms.

The fight against the proposed Medicaid changes will almost certainly include lawsuits, with opponents of work requirements likely to argue that such alterations fundamentally undermine the program’s goal of providing for the health care needs of millions of low-income individuals.

The move to facilitate state implementation of such requirements is in line with the vision Seema Verma, the Trump-appointed Centers for Medicare and Medicaid Services administrator, has laid out for her tenure at the agency.

“CMS believes that meaningful work is essential to beneficiaries’ economic self-sufficiency, self-esteem, well-being and health of Americans,” Verma told state officials in a speech before the National Association of Medicaid Directors in November of 2017.

“Believing that community engagement requirements do not support the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration,” Verma went on to add.

There are currently nine states—Arizona, Arkansas, Indiana, Kentucky, New Hampshire, Maine, Wisconsin, Kansas and Utah—that have asked the Trump administration to approve Medicaid waivers that include work requirements. South Dakota officials have signaled their intent to join that growing list. Experts have speculated that Kentucky is likely to be the first state to see its work requirement waiver approved.

Kentucky’s pending Medicaid waiver would require beneficiaries to spend 20 hours per week engaged in “employment activities” in order to continue to qualify for the program. Those activities could include: traditional employment, job search, job training, education, volunteer work or caring for a non-dependent relative or person with a disabling chronic condition. Additionally, under the proposed waiver, Kentucky would disenroll any beneficiaries that make false statements regarding employment status and bar them from re-enrolling in the program for six months. Kentucky itself has estimated that as many as 95,000 fewer people would be covered by its Medicaid program by year five under the pending waiver compared with the current program in large part because of the six-month lockout period and the employment hours requirement.

In the past, administrations have rejected any move by states that would make it more difficult for low-income Americans to enroll, or remain enrolled, in Medicaid, citing the parameters of such waivers laid out by Section 1115 of the Social Security Act. Under that law, a state can implement an “experimental, pilot or demonstration project which, in the judgment of the Secretary [of Health and Human Services], is likely to assist in promoting the objectives of [Medicaid] in a state or states.” Barriers to coverage and care, some have argued, do not constitute a furthering of those objectives.

Opponents of employment requirements are also quick to note that recent research on the Medicaid-enrolled population has found that most of the adult enrollees who can work, already do work. A Kaiser Family Foundation survey from February 2017 found that 59 percent of adults that would be covered by these work requirements are already working. And those who are not working reported serious impediments to being able to maintain a job. More than one-third of those polled reported that an illness or disability prevented them from being employed.

Quinn Libson is a Staff Correspondent at Government Executive’s Route Fifty and is based in Washington, D.C.

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