States urged to re­quire work for Med­i­caid help

Or­der is shift in how care for poor is ad­min­is­tered

The Arizona Republic - - Front Page - Heidi M. Przy­byla USA TO­DAY

The Trump ad­min­is­tra­tion says it will en­cour­age states to place work re­quire­ments on Med­i­caid re­cip­i­ents, a step to­ward a long-stand­ing GOP goal of over­haul­ing the pro­gram serv­ing low-in­come Amer­i­cans. The or­der would mark a sig­nif­i­cant shift in how the health-care plan is ad­min­is­tered.

WASH­ING­TON – The Trump ad­min­is­tra­tion said Thurs­day it will en­cour­age states to place work re­quire­ments on Med­i­caid re­cip­i­ents, a first step to­ward a GOP goal of over­haul­ing the pro­gram serv­ing low-in­come Amer­i­cans.

Seema Verma, head of the Cen­ters for Medi­care and Med­i­caid Services, is­sued guid­ance in­tended to help states de­sign pro­grams en­cour­ag­ing “able­bod­ied, work­ing-age Med­i­caid ben­e­fi­cia­ries” to par­tic­i­pate in skills train­ing, ed­u­ca­tion, job search, vol­un­teer­ing or care giv­ing.

The or­ders would mark a sig­nif­i­cant shift in how the Med­i­caid pro­gram — gov­ern­ment health care for low-in­come peo­ple — is ad­min­is­tered. It is likely to draw strong op­po­si­tion by Democrats.

“Med­i­caid needs to be more flex­i­ble so that states can best ad­dress the needs of this pop­u­la­tion,” Verma said in an­nounc­ing an ini­tia­tive that could af­fect mil­lions. “Our fun­da­men­tal goal is to make a pos­i­tive and last­ing dif­fer­ence in the health and well­ness of our ben­e­fi­cia­ries.”

CMS said that in ar­eas of high un­em­ploy­ment, ben­e­fi­cia­ries could meet re­quire­ments by car­ing for young chil­dren or el­derly fam­ily mem­bers. States would be re­quired to come up with ways to help ben­e­fi­cia­ries meet the re­quire­ments and to help them find job train­ing, as long as they use non-Med­i­caid funds to do so.

The agency is ex­pected to start ap­prov­ing state waivers pro­mot­ing “com­mu­nity en­gage­ment ac­tiv­i­ties” in com­ing weeks, CMS of­fi­cials said.

Med­i­caid is a fed­eral-state col­lab­o­ra­tion cov­er­ing more than 70 mil­lion peo­ple, or about 1 in 5 Amer­i­cans, mak­ing it the largest gov­ern­ment health in­sur­ance pro­gram. Pres­i­dent Barack Obama ex­panded the pro­gram by al­low­ing states to cover mil­lions more low-in­come adults.

Judy Solomon, vice pres­i­dent for health pol­icy at the Cen­ter on Bud­get and Pol­icy Pri­or­i­ties, a Democratal­igned pol­icy group, said on Twitter that the ini­tia­tive pro­vides no money “for work sup­ports” and that his­tory shows peo­ple who are work­ing and those who should be ex­empt could lose ben­e­fits. “Don’t be fooled by all the bells and whis­tles,” she wrote.

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.

CMS says 10 states have ap­plied for waivers in­volv­ing work re­quire­ments or com­mu­nity in­volve­ment: Ari­zona, Arkansas, In­di­ana, Kansas, Ken­tucky, Maine, New Hamp­shire, North Carolina, Utah and Wis­con­sin.

The or­der may also face le­gal chal­lenges.

Health groups and ad­vo­cates for the poor — in­clud­ing the Na­tional Cen­ter for Law and Eco­nomic Jus­tice and the Amer­i­can Lung As­so­ci­a­tion — dis­pute Verma’s con­tention that the Cen­ters for Medi­care and Med­i­caid Ser­vice has the author­ity to grant such re­quests.

Courts have said states can’t add ad­di­tional re­quire­ments for Med­i­caid el­i­gi­bil­ity that are not in law, the coali­tion wrote. Some bills of­fered in Congress ad­dress such changes, but haven’t yet passed.

MARK WIL­SON/EPA

Seema Verma, head of the Cen­ters for Medi­care and Med­i­caid Services, is­sued guid­ance Thurs­day to help states de­sign pro­grams re­quir­ing work for Med­i­caid re­cip­i­ents. Verma is show with Pres­i­dent Trump in March.

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