Trump policy shift means states could require Medicaid recipients to work

Health and Human Services Secretary Marylou Sudders speaks during a news conference announcing more reforms to combat the opioid crisis at the State House Tuesday

People are not legally required to hold a job to be on Medicaid, but states traditionally can seek federal waivers to test new ideas for the program.

The new policy comes as 10 states are already lined up, waiting for federal permission to impose work requirements on able-bodied adults in the program.

The Trump administration will allow states for the first time to impose work requirements on Medicaid recipients. They are: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

Medicaid, the joint federal-state program that provides low-priced health care, is the largest federal health program with over 70 million participants and has an annual federal budget of over $400 billion.

The agency's guidance provides states with a lot of flexibility in designing their programs and highlights that many recipients may need additional considerations.

A study from the non-partisan Kaiser Family Foundation found that nearly 60% of working-age adults on Medicaid are already employed.

"Medicaid needs to be more flexible so that states can best address the needs of this population", Seema Verma, the head of CMS, said in a statement.

Critics, however, argue that Republicans are using work requirements to thin the Medicaid rolls. But she said a work requirement hasn't been on her radar "because I've been completely focused on restructuring the Medicaid program and making it sustainable for MA". Many of them have jobs that don't provide health insurance.

"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", Verma said.

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States will be required to describe strategies to assist recipients in meeting the requirements and to link them to job training and support resources, including child care and transportation. Moreover, work requirements did not lift people out of poverty.

"This new guidance paves the way for states to demonstrate how their ideas will improve the health of Medicaid beneficiaries, as well as potentially improve their economic well-being", said Brian Neale, CMS Deputy Administrator and Director for the Center for Medicaid and CHIP Services.

"I see this as CMS giving states that are looking for flexibility, flexibility", Sudders said, using the acronym for the Centers for Medicare and Medicaid Services.

"For the future of our country, we need all Americans to be active participants in their communities", she said in November. But many of them are either in school or staying home to care for a family member, while about a third are too sick to work.

Mary Beth Musucemi, associate director of the Kaiser Family Foundation's Program on Medicaid and the Uninsured, said the new approach "will penalize individuals by having them lose health coverage, rather than incentivize them, as a voluntary program with adequately funded supportive services necessary to overcome barriers would".

Medicaid, an important social safety net program created five decades ago and expanded under Republican President Donald Trump's Democratic predecessor Barack Obama, has never had such conditions attached. Aligning requirements across these programs may streamline eligibility and reduce the burden on both states and beneficiaries and help beneficiaries succeed in meeting their work and community engagement responsibilities.

CMS also encourages states to consider a range of activities that could satisfy work and community engagement requirements.

"The likely source of the outbreak in the United States appears to be leafy greens, but officials have not specifically identified a type of leafy greens eaten by people who became ill", the CDC said Wednesday.

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