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CMS goes all in on Medicaid work requirements

12 January 2018, 03:23 | Myrtle Vega

Centers for Medicare & Medicaid Services Administrator Seema Verma

Centers for Medicare & Medicaid Services Administrator Seema Verma

"Under the rules, states can require Medicaid beneficiaries to work, volunteer or participate in job training", reports NPR.

"States are encouraged to create consistent program rules to minimize potential confusion" for beneficiaries who are also enrolled in SNAP or TANF, although the 1115 waiver also could go beyond those programs' requirements in terms of what is considered acceptable community engagement for eligibility purposes, he told MedPage Today.

The major policy shift seeks to overhaul the long-standing social contract between state and federal governments and poor citizens who rely on their services.

"We know that Republicans tend to think of Medicaid more as a welfare program, while Democrats tend to think of it as more of a health insurance program", said Diane Rowland, the Kaiser foundation's leading expert on the program.

"Our policy guidance was in response to states that asked us for the flexibility they need to improve their programs and to help people in achieving greater well-being and self-sufficiency", Verma said. Even people who are employed might lose benefits if they failed to submit pay stubs or other documentation. Advocates for low-income people say they expect Kentucky's waiver to be approved shortly. Medicaid was expanded under former President Barack Obama, with an option allowing states to cover millions more low-income adults.

"Medicaid needs to be more flexible so that states can best address the needs of this population", she said in a statement.

"This is about helping those individuals rise out of poverty", said Seema Verma, administrator for the Centers for Medicare and Medicaid Services.

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Opponents of the proposal say that it opens up the ability for at-risk patients to get denied access and will make it more hard for worthy recipients to get access to care.

Verma, who served as a Medicaid consultant for IN and Kentucky before joining the Trump administration, has long advocated for work requirements.

CMS additionally said the strategy would not make a difference to individuals with inabilities, the elderly, youngsters and pregnant ladies. "We need to work together to find ways to improve the program, instead of restrict it, so that it better provides health care coverage to those who need it". Requiring recipients to work would be illegal because it is not consistent with Medicaid's objectives, said Leonardo Cuello, health policy director of the National Health Law Program.

The changes are an opening salvo in the administration's push this year to overhaul federal safety net programs, with the White House asking departments and agencies across the government to review eligibility for low-income assistance programs.

A study from the non-partisan Kaiser Family Foundation found that nearly 60% of working-age adults on Medicaid are already employed. It would not apply to those getting benefits due to a "disability, elderly beneficiaries, children, and pregnant women".

The historic move would be a significant change in how the government health insurance program operates and would fulfill a longtime Republican goal. Of those without a job, more than a third are ill or disabled, 30 percent are caring for young children, and 15 percent are in school, the analysis shows. Verma and other Republicans said implementing work and community engagement requirements could help improve health outcomes by connecting people with jobs and training.

Verma also had a major role in designing an unorthodox approach to Medicaid in IN, which had asked the Obama administration to approve a work requirement.



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