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Medicaid work requirements are a throwback to rejected racial stereotypes

14 January 2018

The Trump Administration moved Thursday to allow states to impose work requirements on their Medicaid programs for the first time, the latest adjustment of the nation's health-care system through administrative action after Republican efforts to repeal Obamacare failed previous year.

The big news Thursday morning - besides President Trump undercutting his own White House on FISA - was that his administration is moving to allow states to impose work requirements on Medicaid recipients. The office plans to take a close look at how their waiver can align with the new federal guidelines.

The Trump administration initiative is "designed to assist states in their efforts to improve Medicaid enrollee health and well-being by incentivizing work and community engagement among non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability", according to the Department of Health and Human Services paper. Kaiser's analysis of recipients shows that 60 percent of non-disabled individuals who receive benefits have a job, with 80 percent of recipients living in a family unit with at least one person in the work force.

Steve Wagner with the Universal Health Care Action Network says there are many reasons why Medicaid beneficiaries may be unemployed, but being unmotivated is not at the top of the list. Gov. Matt Bevin, a Republican, first sought to add such a provision in 2016.

Such waivers, if approved, can be used to exempt individual states from certain regulatory requirements regarding the administration of the Medicaid program.

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.

Under the proposed work requirement, people will have to prove that they're working or performing some other qualifying activity such as volunteering.

"Only exempting individuals eligible "based on a disability" leaves many people with disabilities at risk of losing coverage for which they remain eligible, if they can not comply with the requirements, verify their compliance, or successfully document an exemption", Musumeci said.

The new plan sets the stage for a potentially long and contentious legal battle over the shape and goal of a health program that more than 70 million Americans now depend on.

Solomon, the advocate for low-income people, said the federal government's waiver authority doesn't provide carte blanche to ignore the basic purposes of the program, and promoting work has not been on that list up to now.

Medicaid work requirements are a throwback to rejected racial stereotypes
Medicaid work requirements are a throwback to rejected racial stereotypes

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

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

"There's absolutely nothing that requires the exemption of people with addiction", Rosenbaum said.

Sometimes, amazingly, I know, politicians do things just because they are heartless, soulless bastards who deserve to be eaten by Denebian slime-devils and then vomited into the fires of Mount Doom.

How the new policy affects providers is so far unknown. The guidance also says that states should also consider "caregiving for young children or elderly family members". Patty Murray, D-Washington, the ranking Democrat on the Senate health committee, said it "speaks volumes" about President Trump's priorities that CMS would pursue a policy she said would "pull the rug out from people who simply want affordable health care they can rely on".

The Trump administration's memo, which was released on Thursday, says the move would be aimed at encouraging able-bodied, working age Medicaid recipients to work or get involved in what it called "community engagement".

"If you're not healthy, it's hard to work", said Mike Bare, research director for Community Advocates' Public Policy Institute in Milwaukee.

Verma stressed that the administration is providing an option for states to require work, not making it mandatory.

Federal Medicaid officials said that work requirements should be compared to work requirements 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.

Many people can have physical or mental health problems - such as arthritis or asthma - that don't meet the criteria for federal disability programs, but still interfere with their ability to work, Kaiser said.

Medicaid work requirements are a throwback to rejected racial stereotypes