Trump opens path for states to seek work requirements for Medicaid

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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.

Republicans have long wanted to add work requirements for Medicaid recipients - which covers almost 75 million low-income children, adults and elderly and disabled Americans.

It's unclear which states will be the first to pursue a first-of-its-kind Medicaid work requirement waiver.

"This gives us a pathway to start approving waivers", Verma said on a call with reporters.

A University of MI team recently published data in JAMA Internal Medicine from detailed survey of more than 4,000 MI residents enrolled in the state's expanded Medicaid program. "This policy helps people achieve the American dream". Some Medicaid recipients say the coverage has enabled them to get healthy enough to return to work. Imposing a work requirement to be eligible for Medicaid not only fails to further the goal of providing health care, but also undermines the underlying objective. It is likely to prompt a lawsuit from patient advocacy groups, which claim the requirement is inconsistent with Medicaid's objectives and would require an act of Congress. "They want to develop programs that will help them break the chains of poverty and live up to their fullest potential".

However, the Obama administration did not approve any state waivers that would impose work mandates, saying it was not in keeping with the program's mission to provide access to medical services.

Ten states - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin - requested the ability to put the work requirements in place, according to the CMS statement.

The Louisiana Budget Project, which advocates for low- to moderate-income families, said many nonworking Medicaid recipients have circumstances that make it hard for them to work. Gov. Matt Bevin, a Republican, first sought to add such a provision in 2016.

The CMS guidance gives states a great deal of flexibility to define their own exceptions to a work requirement, as well as what counts toward work.

Kentucky, which has some of the poorest counties in the country, has seen its Medicaid enrollment double in the past three years after the state expanded eligibility under the ACA.

Edwards said he wants the work requirements to be "reasonable", with exceptions for people in school or training programs.

While states should help people on Medicaid meet their requirements - for instance, by helping them find child care, transportation or job-training - they may not use any Medicaid funds to do so, the letter says.

"We're looking at people who are able-bodied, and it has to accommodate those who are in work training or education", he said.

While some conservatives pressed her agency to quickly issue guidelines, lawyers within the Health and Human Services and Justice departments jockeyed for time to construct a legal justification that they hope can withstand court challenges.

"There's never been a work requirement in Medicaid, it's only been in recent years that states have raised the possibility of having one", she said.

But congressional Democrats said the Trump administration is moving in the wrong direction.

Republicans lawmakers have repeatedly failed to repeal and replace Obamacare, a top Trump campaign promise.

In its guidance to states, CMS said they should consider how some communities have high unemployment rates and whether enrollees need to care for young children or elderly relatives. States should try to align their Medicaid work requirements with similar conditions applying in other programs, such as food stamps.

"CMS recognizes that a broad range of social, economic, and behavioral factors can have a major impact on an individual's health and wellness, and a growing body of evidence suggests that targeting certain health determinants, including productive work and community engagement, may improve health outcomes", said the Centers for Medicaid and CHIP Services (CMCS) Director Brian Neale. The requirement would not apply to some participants, including pregnant women, those being treated for substance abuse, "the medically frail" and those older than 60.

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