Some on Medicaid may have to work
WASHINGTON — The Trump administration said Thursday that it would allow states to impose work requirements in Medicaid, a major policy shift in the health program for low-income people.
Federal officials said they would support state efforts to require ablebodied adults to engage in work or other “community engagement activities” as a condition of eligibility for Medicaid.
“Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today’s announcement is a step in that direction,” said Seema Verma, the administrator of the federal Centers for Medicare
and Medicaid Services.
In Texas, Gov. Greg Abbott and Lt. Gov. Dan Patrick did not respond to questions about whether they want to impose work requirements on state Medicaid enrollees. The state’s Health and Human Services Commission, which oversees the health care program, also did not return a request for comment.
Verma said the Trump administration was responding to requests from Medicaid officials in 10 states that wanted to run demonstration projects testing requirements for work or other types of community engagement like training, education, job search, volunteer activities and caregiving.
With Thursday’s announcement, Trump administration officials are moving to fulfill a conservative vision for one of the nation’s largest social insurance programs, allowing work requirements in Medicaid somewhat similar to those already imposed in other programs like food stamps, now known as the Supplemental Nutrition Assistance Program, and the welfare program known as Temporary Assistance for Needy Families.
In a speech to state Medicaid officials in November, Verma indicated that the Trump administration would be receptive to work requirements and other conservative policy ideas to reshape Medicaid. And she criticized the Obama administration, saying it had focused on increasing Medicaid enrollment rather than helping people move out of poverty and into jobs.
“Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration,” Verma said. “Those days are over.”
The Medicaid proposals came from Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. Several other states are considering work requirements.
Possible court challenges
In Texas, the health care program primarily insures lowincome children, who make up more than 75 percent of the 4.4 million enrollees, according to the Austin-based Center for Public Policy Priorities. Texas has one of the lowest qualifying incomes in the country for adults, and is one of 18 states that did not expand Medicaid under the Affordable Care Act
Only a small percentage of low-income Texans who get their health care through Medicaid would have to work to receive benefits, should the state decide to adopt work requirements, according to figures provided by an advocacy organization
“I’ve said for years that Medicaid is a costly and broken system, and that we need to explore all available options to put this program on a more sustainable fiscal trajectory,” said Sen. Charles Schwertner, who chairs the chamber’s Health and Human Services Committee. “I believe that every Medicaid or welfare recipient who is capable of working, particularly those in expansion states, should be expected to bear some responsibility for the cost of their own health care,”added the Georgetown Republican
Sen. Carlos Uresti, who is vicechair of the committee, said the Legislature should further study the issue.
“The data shows if you are on Medicaid you are very likely disabled, elderly, pregnant or a child,” said Uresti, D-San Antonio, in a statement. “The Legislature should further study the issue, just as we have other Medicaid eligibility requirements, before making any decisions that could unnecessarily drive families and children further into poverty.”
Advocates for Medicaid beneficiaries said the new federal policy was likely to be challenged in court if people were denied coverage for failure to meet a state’s work requirement.
Federal law gives the secretary of health and human services broad authority to grant waivers for state demonstration projects that “promote the objectives” of the Medicaid program. In the past, federal officials said that work was not among those objectives.
But Trump administration officials said Thursday that work requirements were consistent with the goals of Medicaid, because work and work-related activities could improve the health of Medicaid beneficiaries.
“Productive work and community engagement may improve health outcomes,” Brian Neale, the director of the federal Medicaid office, said Thursday in a letter to state Medicaid directors. “For example, higher earnings are positively correlated with longer life span.”
Federal and state officials and health policy experts said that Medicaid beneficiaries could work at a variety of jobs — as cashiers, telemarketers, housekeepers, nursing and home health aides, child care providers, cooks and dishwashers, waiters and waitresses, retail sales clerks, landscapers, security guards and construction laborers, for example. They could also work as volunteers at food pantries and other charitable organizations.
Democrats criticize policy
The Trump administration said that states imposing work requirements must have plans to help people meet those requirements and should help arrange job training, child care and transportation as needed. But, it said, states cannot use federal Medicaid funds to pay for such “supportive services.”
Medicaid has a major role in combating the opioid epidemic, paying for a wide range of treatments and medications. But people addicted to opioids are often unable to work or to find jobs, and some employers are reluctant to hire people who fail drug tests.
Verma said the Trump administration would require states to make “reasonable modifications” of their work requirements for people who are addicted to opioids or have other substance use disorders.
The Trump administration said that state Medicaid officials could not impose work requirements on pregnant women, elderly beneficiaries, children or people who were unable to work because of a disability. States must also create exemptions for people who are “medically frail.”
Despite such exemptions, Democrats called the new policy inhumane, mean-spirited and malicious, echoing criticism of work requirements in a welfare law adopted in 1996.