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Trump work requirement rewrites health care rules for poor

WASHINGTON (AP) — Rewriting the rules on health care for the poor, the Trump administration said Thursday it will allow states to require “able-bodied” Medicaid recipients to work, a hotly debated first in the program’s half-century history.

 

January 12, 2018



WASHINGTON (AP) — Rewriting the rules on health care for the poor, the Trump administration said Thursday it will allow states to require “able-bodied” Medicaid recipients to work, a hotly debated first in the program’s half-century history.

Seema Verma, head of the Centers for Medicare and Medicaid Services, said requiring work or community involvement can make a positive difference in people’s lives and in their health. The goal is to help people move from public assistance into jobs that provide health insurance. “We see people moving off of Medicaid as a good outcome,” she said.

But advocates said work requirements will become one more hoop for low-income people to jump through, and many could be denied needed coverage because of technicalities and challenging new paperwork. Lawsuits are expected as individual states roll out work requirements.

“All of this on paper may sound reasonable, but if you think about the people who are affected, you can see people will fall through the cracks,” said Judy Solomon of the Center on Budget and Policy Priorities, which advocates for the poor.

Created in 1965 for families on welfare and low-income seniors, Medicaid now covers more than 70 million people, or about 1 in 5 Americans. The federal-state collaboration has become the nation’s largest health insurance program.

Beneficiaries range from pregnant women and newborns to elderly nursing home residents. Medicaid was expanded under former President Barack Obama, with an option allowing states to cover millions more low-income adults. Many of them have jobs that don’t provide health insurance.

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.

Verma stressed that the administration is providing an option for states to require work, not making it mandatory across the country. Her agency spelled out safeguards that states should put in place to get federal approval for their waivers.

States can also require alternatives to work, including volunteering, caregiving, education, job training and even treatment for a substance abuse problem.

The administration said 10 states have applied for waivers involving work requirements or community involvement. They are: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. Advocates for low-income people say they expect Kentucky’s waiver to be approved shortly.

Thursday’s administration guidance spells out safeguards that states should consider in seeking work requirements. These include:

—Exempting pregnant women, disabled people and the elderly.

—Taking into account hardships for people in areas with high unemployment, or for people caring for children or elderly relatives.

—Allowing people under treatment for substance abuse to have their care counted as “community engagement” for purposes of meeting a requirement.

The administration said states must fully comply with federal disability and civil rights laws to accommodate disabled people and prevent those who are medically frail from being denied coverage. States should try to align their Medicaid work requirements with similar conditions in other programs, such as food stamps and cash assistance.

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.

“This is a very complex issue that will require thoughtful and nuanced approaches,” said the group.

Trump’s new direction can be reversed by a future administration. Although waivers can have lasting impact they don’t amount to a permanent change in the program. They’re considered “demonstration programs” to test ideas. The administration says the impact will be closely evaluated.

“We know that Republicans tend to think of Medicaid more as a welfare program, while Democrats tend to think of it as more of a health insurance program,” said Diane Rowland, the Kaiser foundation’s leading expert on the program. “It will be interesting to see how states are going to make this work for people.”

 
 

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