Trump opens the way for a Medicaid work requirement
“Medicaid needs to be more flexible so that states can best address the needs of this population.”
Seema Verma, Centers for Medicare and
Medicaid Services
WASHINGTON – The Trump administration said Thursday it will encourage states to place work requirements on Medicaid recipients, a first step toward a longstanding GOP goal of overhauling the program serving low-income Americans.
Seema Verma, head of the Centers for Medicare and Medicaid Services, issued new guidance intended to help states design programs encouraging “able-bodied, 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 political opposition from Democrats.
“Medicaid needs to be more flexible so that states can best address the needs of this population,” Verma said in a statement 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,” she said.
In areas of high unemployment, CMS said in a statement that 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 nonMedicaid funds to do so.
The agency is expected to start approving state waivers promoting “community engagement activities” in coming weeks, according to CMS.
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 also may 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 CMS 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 passed yet.
“Most people on Medicaid who can work, do so,” the coalition wrote, “and for people who face major obstacles to employment, harsh requirements won’t help them overcome them.”