Spotlight Exclusives

Changes to Medicaid Requirements Alarm Advocates for Low-Income Americans

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Anti-poverty activists decried the announcement Thursday by the Trump administration that, for the first time, states would be able to require people to work or be preparing for employment in order to receive Medicaid.

A letter to state Medicaid directors said the federal Centers for Medicare and Medicaid Services will now permit states to block certain low-income adults from getting Medicaid coverage if they are not working or participating in “community engagement activities” including skills training and education.

The letter also details who could be excluded from work requirements, including children, anyone with a disability, and people being treated for opioid addiction.

 The Washington Post reported that 10 states have already requested permission to begin imposing work requirements, and three others are contemplating such a request. The first such waiver, probably for Kentucky, could be approved by Friday. The 10 states already requesting a waiver are: Arizona, Utah, Kansas, Arkansas, Wisconsin, Indiana, Kentucky, North Carolina, New Hampshire, and Maine.

The Kentucky request would require able-bodied adults without dependents to work at least 20 hours a week.

A poll conducted last year by the Kaiser Family Foundation and the Harvard Opinion Research Program found that 70 percent of Americans approve of  work requirements for Medicaid for non-disabled adults, including 80 percent of Republicans. Several congressional Republicans have been calling for work requirements for eligible Medicaid recipients since the Affordable Care Act expanded Medicaid to millions more people.

Criticism of the administration’s action was swift, however, among Democrats in Congress and many experts and activists in the poverty policy world.

President Trump “has officially ended Medicaid as we know it, by allowing states to take health insurance away from people who can’t find a job,” tweeted Rebecca Vallas, managing director of the Poverty to Prosperity Program at the Center for American Progress.

In a blog post for the Center on Budget and Policy Priorities, Hannah Katch argued that the policy won’t succeed in getting people to work and that experience shows that eligible people will lose coverage via paperwork requirements, while others may have conditions that inhibit them from working even if they don’t meet federal disability requirements.

Rep. Cedric Richmond (D-LA), chairman of the Congressional Black Caucus, released a statement calling the new policy “counterproductive and most likely illegal.” Said Richmond: “The policy announced today is a sad and shameful attack on the most vulnerable among us. The last thing Americans who have fallen on hard times need is to lose their healthcare so Washington Republicans can take a political victory lap at their expense.”

In a call with reporters Thursday, CMS Administrator Seema Verma countered that the new policy is about “helping people achieve the American Dream.” She said that if the change results in Medicaid enrollment declining, that should be viewed as a positive. “We see moving people off Medicaid as a good outcome because that means they do not need the program anymore and have transitioned to a job or can afford insurance,” she said.

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