Trump policy shift means states could require Medicaid recipients to work

The Trump administration's move allows states to deny medicaid if an able-bodied adult doesn't have a job

The Trump administration's move allows states to deny medicaid if an able-bodied adult doesn't have a job

The Trump administration issued guidance Thursday permitting states to cut a person's health insurance off unless they work or engage in other community activities.

On January 11, the federal Centers for Medicare and Medicaid Services announced it would allow states to apply for permission to require Medicaid beneficiaries to work or pursue other "community engagement" activities such as volunteering, education and caregiving.

Announcement of the new guidance delivers on the commitment made by Administrator Verma in her address to state Medicaid directors last November, to "turn the page" in the Medicaid program and give states more freedom to design innovative programs that achieve positive results for the people they serve and to remove bureaucratic barriers that block states from achieving this goal.

Critics say the rules could mean more Americans are left without health insurance. Kaiser polling past year found that 70 percent of the public support allowing states to impose work requirements on Medicaid recipients, even as most people in the USA were against deep Medicaid cuts sought by congressional Republicans and the Trump administration. "We see people moving off of Medicaid as a good outcome", she said.

As of October 2017, almost 75m individuals were enrolled in Medicaid and the children's health insurance program (Chip).

Solomon, the advocate for low-income people, said the federal government's waiver authority doesn't provide carte blanche to ignore the basic purposes of the program, and promoting work has not been on that list up to now. So far, 10 states sought federal approval to upend their Medicaid programs. That exemption also covers people undergoing treatment for substance abuse problems. In 1996, a welfare reform bill passed by the Republican-controlled congress and signed by President Bill Clinton, a Democrat, added work requirements to welfare benefits, among other changes to the welfare program now known as Temporary Assistance to Needy Families.

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"In a time of heated debate and division, helping Americans at or near the poverty line improve their lives and no longer need public assistance should be a cause that unites us all", Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said Wednesday in a conference call previewing the move.

Verma has recused herself from ruling on those two states' requests but has imported the ideas behind them into the new federal policy.

About 40 percent of nonelderly, non-disabled adults who have Medicaid coverage aren't working, according to an analysis from the Kaiser Family Foundation. Just 6 percent say they want to work but can't find a job.

Recipients who aren't working were mostly taking care of a relative, attending school or too sick.

The report also states that people with a full-time job are less likely to suffer from depression. 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. Demonstrations, which give states additional flexibility to design and improve their programs, are also created to evaluate state-specific policy approaches and better serve Medicaid populations.

Verma also had a major role in designing an unorthodox approach to Medicaid in IN, which had asked the Obama administration to approve a work requirement.

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