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Trump’s new plan: Get a job if you want Medicaid
Gage Skidmore / CCL
The Trump administration revealed a new plan on Thursday that paves the way for states to require able-bodied Medicaid enrollees to work, volunteer, or take classes. While it falls short of comprehensive welfare reform, so-called “work requirements” for Medicaid would be a major step toward streamlining the system.
The Trump administration believes the changes will help welfare dependents move into jobs that provide health insurance.
Under the Obama administration, Medicaid expanded significantly while “work requirements” were entirely ignored.
States can now set work requirements
The new guidelines would allow states to require enrollees to work, volunteer, take classes or enroll in work training to receive Medicaid. States would be able to set up alternatives to the work requirement, including caring for a disabled child or elderly citizen and would be able to set the number of weekly work hours needed.
These guidelines encourage states to exempt the elderly, disabled, pregnant women, and children. People seeking treatment for opioid addiction would be allowed to have their care counted as “community engagement.” The guidelines also encourage states to consider hardships for people living in areas with high unemployment or for people caring for children or elderly relatives.
Not a federal mandate
Seema Verma, the administrator for the Centers for Medicare and Medicaid Services, said the requirements were not federal mandates. States will retain the right to decide whether they want to ask for a waiver to enforce the requirements.
“This is in response to proposals we are receiving from states. It is entirely optional for states,” Verma said. “This is in no way a requirement.”
10 states have asked to be allowed to impose work requirements: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin. States must wait for CMS to approve their waiver before setting up programs.
Since waivers are considered trials and not permanent policy changes, states would have to track the results, including how many people lose coverage.
Establishing work requirements for Medicaid is a popular idea. A Kaiser Family Foundation poll found that 70 percent of Americans supported work requirements.
Medicaid now covers 1 in 5 Americans. Under Obama, the program expanded significantly to cover millions more adults. The Obama administration also opposed allowing states to enforce work requirements.
The federal government covered the Medicaid expansion completely at its outset in 2014, but that coverage is expected to sunset to 90 percent by 2020, by which time states could be paying millions or even billions more to cover their Medicaid rolls.
The idea that Medicaid recipients don’t work is inaccurate; about 60 percent work either full-time or part-time, typically for employers that don’t provide health insurance. But Medicaid was never meant to be a safety net for 20 percent of Americans.
Since a majority of Medicaid recipients already work, most would not be affected by states who choose to set requirements. As for the remainder who do not work, those who have a legitimate reason not to would likely fall under one of the exemptions.
As a net result, most would stay where they are. The primary difference would be money saved by cutting welfare abusers off the program who are able, but refuse, to work.
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