Trump's good idea on Medicaid reform: Honchariw

Centers for Medicare and Medicaid Services administrator during her Senate Finance Committee confirmation hearing in Washington on Feb. 16 2017. MUST CREDIT Bloomberg

However, because the administration is legally bound to justify the change as furthering the goals of the low-income medical insurance program, Medicaid's top bureaucrat, Seema Verma, has argued that the requirement will improve health, based on evidence that richer people tend to be healthier.

The change will allow states to craft programs that would require Medicaid recipients to prove they are working, training for a job, or volunteering in their communities, according to guidance issued by the Centers for Medicare and Medicaid Services.

Wolf vetoed a budget-related bill a year ago that would have required the administration to include a work-search requirement in the Medicaid program.

In a letter to state Medicaid directors, the White House is signaling a willingness to approve state requests to require people seeking health coverage through the Medicaid program to have a job or participate in other approved forms of "community engagement".

The work requirement does not affect pregnant women, the elderly, the disabled, and, of course, children.

CMS says that states should "consider" not imposing work requirements on groups including caregivers, people with health problems, or full-time students. The addition of a work requirement moves us further away from the idea of health care as a right and towards an America that does not provide a safety net for the most vulnerable, including people with disabilities.

Soon, the administration will likely approve "waiver" proposals, starting with Kentucky and IN and followed by other states, to end Medicaid coverage not only for people who aren't working, but also for those who didn't pay premiums - or renew their coverage - on time.

Kentucky, where the uninsured rate for low-income adults plummeted under the Medicaid expansion (from almost 40% in 2013 to 7% at the end of 2016), estimates its proposed changes will cut enrollment by 15% in five years. They generally work in low-wage or minimum-wage jobs that offer either unaffordable health insurance or none at all.


It's more common for Medicaid enrollees to hold jobs if they live in states that expanded Medicaid under Obamacare. By that time their health care will be much more expensive to the state (if they survive that long).

In Massachusetts, employers are facing a shortage of workers in a low unemployment economy and state officials are struggling to cover the cost of growing Medicaid enrollment in the face of threatened cuts in federal health care spending.

He also believes the work requirement may be financially counter productive.

Opponents of the move quickly decried the Trump administration's action, arguing that it represented a gutting of Medicaid and the administration's disregard for the poor (which was a big part of the pushback against the failed effort to replace Obamacare). While the provision is itself regressive, funneling money into the pockets of the private insurance companies, the result will be more people losing their insurance and premiums skyrocketing for those who maintain it. Similarly, 60 percent of Nevadans who gained Medicaid coverage via the ACA expansion didn't work at all during 2015.

The new policy would not apply to people who qualify for the program because of a disability, the memo said. These able-bodied men and women are the ones who will be required to find work in order to keep their Medicaid benefits.

All the policy will do, Berg said, is increase bureaucracy and paperwork, "supposedly from the small government people", because it will force working people to leave work, or those on a job search to stop searching and have to go to a government office to fill out a form to show they are working or searching for a job. Calling the new policy "unconscionable and illegal", Eliot Fishman, senior health policy director at the liberal consumer health lobby Families USA, said in a statement: "Today's announcement isn't about work". No state or federal administrator can add another requirement that is not in federal law. That represents about 15 million people.

Federal Medicaid officials compared a work requirement to similar conditions in other programs like food stamps, now known as the Supplemental Nutrition Assistance Program, and the welfare program known as Temporary Assistance for Needy Families.

"It's basically creating layers of government, confusion, bureaucracy that doesn't need to be there for people who are probably working anyway", she said. Additionally, the guidance details that states can not accrue savings from loss in enrollment due to work requirements, which means that states will need to pay for any work requirement administrative burden, such as determining if an individual is working, developing an enrollee reporting system and employment supportive services, etc. If I were reliant on Medicaid in a state with a work requirement, I would have had to pay for years of testing and doctor appointments myself before I finding a doctor willing to sign off on a work exemption.

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