NH GOP leaders plan to add Medicaid work requirement

Kentucky Gov. Matt Bevin announces federal approval of Kentucky's Medicaid waiver in the Capitol Rotunda in Frankfort Ky. Friday Jan. 12 2018

Donald Trump's administration moved Thursday to let states require that able-bodied adults work in order to receive health care benefits through Medicaid, a pillar of the U.S. social safety net.

Conservatives around the country, however, hailed the change to the federal-state program for low-income people.

But Cuello noted that many more beneficiaries will be affected by the new, more complex requirements, such as people who are exempt from work because of a chronic illness but will have to prove they are exempt.

Milliman, an Indianapolis-based actuarial firm hired by the state to evaluate its program, predicts just under 133,000 Hoosiers on the state's Medicaid expansion HIP 2.0 would be subject to the work requirement.

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At least 10 states, led by Republicans, were awaiting federal permission to enforce the new work rules, according to the Washington Post. That Medicaid expansion was sharply criticized by conservatives, and Republicans in Congress tried to add work requirements in their unsuccessful bid past year to overturn the health law. Several other states are considering such work requirements. Utah enacted a slim Medicaid expansion for chronically homeless people with substance abuse issues, and ME voters passed Medicaid expansion last fall - although its implementation is up in the air. The Center for Children and Families at Georgetown University, citing the state's own projections, said the waiver provision could disqualify almost 100,00 Kentuckiansfrom Medicaid in the next five years.

Governor Matt Bevin made a public announcement Friday afternoon about the waiver. The change will require adults between the ages of 19 and 64 to complete 80 hours per month of "community engagement" to keep their coverage. But, it said, states can not use federal Medicaid funds to pay for such "supportive services". During the Obama Administration, 32 states expanded their Medicaid programs to include low-income adults, making health insurance available to poor working people.


"The truth is, people are going to lose Medicaid coverage", he said.

The new guidance, however, could reverse this trend by allowing states to impose work or "community engagement" requirements for Medicaid coverage.

Imposing work requirements does none of that. A Kaiser Family Foundation analysis previous year found that most of the 10 million Medicaid enrolled adults had legitimate excuses for not working with only 6 percent unemployed because they could not find a job. The failed efforts in the House to replace Obamacare included a work requirement for Medicaid. "It's making people healthier that enables them to work", he said.

The state will still have to apply for a waiver and undergo the full federal review process, but CMS will now support state efforts to "test incentives that make participation in work or other community engagement a requirement for continued Medicaid edibility", according to the January 11 letter.

Jami Snyder, deputy director of the Arizona Medicaid program, said a key goal for the state is to help people find jobs - not to reduce its Medicaid enrollment, which stands at 1.9 million.

Federal and state officials and health policy experts said 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.

The work requirement submitted as part of Kentucky's Medicaid waiver is aimed largely at "able-bodied" adults added to Medicaid under the Affordable Care Act and would exclude the elderly, disabled, medically frail or some caring for children or other relatives. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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