Tuesday, 18 December, 2018

Trump to let states require employment for Medicaid

FILE- Gov. Charlie Baker listens as Health and Human Services Secretary Marylou Sudders speaks during a news conference on Tuesday Trump to let states require employment for Medicaid
Pablo Mccormick | 12 January, 2018, 00:35

States are also required to incorporate opioid and substance abuse treatment programming into 1115 demonstrations with flexible work requirements. The guidance also includes caregiving as one of the activities. Those who have a job, are in school or care for young children will need to document to their state's Medicaid agency that they are in compliance - or risk losing their benefits. "Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries".

"Many lives are at stake if today's CMS decision stands", said Eliot Fishman, senior director of health policy of Families USA. The work requirements will likely be challenged in court. Many governors, including Republican ones, have defended the Medicaid program as being critical to addressing the substance abuse crisis.

But it makes suggestions for states as to what counts as work, including state work programs, job training, volunteering, or caring for a relative. However, they will not be allowed to use federal Medicaid funding to finance these services.

Such regulations are already in place for most recipients of Supplemental Nutrition Assistance Program, commonly known as food stamps. Medicaid was expanded under former President Barack Obama, with an option allowing states to cover millions more low-income adults.

"While work requirements are meant to promote work among those not working, coverage for those who are working could be at risk if beneficiaries face administrative obstacles in verifying their work status or documenting an exemption", KFF said.

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CMS officials said they did not have any estimates on how much Medicaid enrollment would drop as a result of the policy.

Trump's new direction can be reversed by a future administration. Many believe this healthcare program is a free ride for those who do not wish to work. "They want to develop programs that will help them break the chains of poverty and live up to their fullest potential".

The guidance states that a review of studies showed, "strong evidence that unemployment is generally harmful to health, including higher mortality; poorer general health; poorer mental health; and higher medical consultation and hospital admission rates".

She said the new policy came about at the request of 10 different states including Kentucky, Maine, New Hampshire, Arizona, Indiana and Utah. "They're trying to be responsive to states".

It's unclear which states will be the first to pursue a first-of-its-kind Medicaid work requirement waiver. Now, she is in a position to approve them.

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"This action by the Trump administration goes after people who are just trying to get by", Democratic U.S. Senator Ron Wyden of OR said.

Thursday's administration guidance to states spells out safeguards that states should consider in seeking work requirements. "Those days are over". A study in December in JAMA Internal Medicine found that about half of the Medicaid recipients in MI were already working. Most of those who don't work cite illness, disability or family obligations as the reason.

In the states that adopt such requirements, critics say, the effect will spread far beyond the healthy adults who do not already comply. To get around this, the 10-page letter argues that working promotes good health and repeatedly asserts that the change fits within the program's objectives. They could find it difficult to apply for exempt status and verify it, which may need to be done monthly in some states, while those who are working may have a hard time verifying their hours, especially if they have variable shifts.

"I see this as CMS giving states that are looking for flexibility, flexibility", Sudders said, using the acronym for the Centers for Medicare and Medicaid Services.

Mary Beth Musucemi, associate director of the Kaiser Family Foundation's Program on Medicaid and the Uninsured, said the new approach "will penalize individuals by having them lose health coverage, rather than incentivize them, as a voluntary program with adequately funded supportive services necessary to overcome barriers would".

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