The Trump administration on Thursday unveiled guidance allowing states for the first time to impose work requirements in Medicaid, a major shift in the health insurance program for the poor.
The move opens the door for states to apply for waivers to allow them to require Medicaid enrollees to work in order to receive coverage, something that has never before happened in the 50-year history of the program.
Seema Verma, the administrator of the Centers for Medicare and Medicaid Services (CMS), says the move will help people get out of poverty.
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“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 in a statement.
Democrats are sharply opposed to the changes, saying people will lose coverage if they can’t meet the requirements or simply because new bureaucratic hurdles will discourage them from applying.
Democratic groups are expected to sue over the changes, arguing that the administration does not have the power to make them without action from Congress. Approving waivers from states must be done to further the “objectives” of the Medicaid program, which Democrats argue is not accomplished by a policy that could cause people to lose insurance.
“Today’s attack on Medicaid is just the latest salvo of the Trump Administration’s 2018 war on health care,” Brad Woodhouse, director of the pro-ObamaCare group Protect Our Care, said in a statement. “Having faced overwhelming public rejection of their failed attempts to repeal health care, Trump and his Congressional Republicans are now going for death by a thousand cuts.”
Asked about the possibility of dropping Medicaid enrollment as a result of the new policy, Verma said on a press call that it is a good thing if people leave Medicaid and find coverage through employers.
“People moving off of Medicaid is a good outcome because we hope that that means they don’t need the program anymore,” Verma said.
The counterargument is that people could also simply become uninsured if they are forced off of Medicaid due to the new requirements.
Verma also defended the legality of the move when asked about court challenges, saying that the waiver language in existing law gives the administration “broad authority.”
Experts said the move is a dramatic shift in Medicaid.
“Conditioning Medicaid eligibility and coverage on work is a fundamental change to the 50 plus year history of the Medicaid program,” MaryBeth Musumeci, Associate Director of the Kaiser Family Foundation’s Program on Medicaid and the Uninsured, wrote in an email.
“There is a real risk of eligible people losing coverage due to their inability to navigate this process or miscommunication or other breakdowns in the administrative process,” she added.
Ten states are currently applying to impose work requirements in Medicaid. Many experts expect Kentucky will be the first state approved.
CMS officials emphasized that the work requirements would only apply to “able-bodied” adults, and has exemptions for children, the elderly, and people with disabilities.
States can also designate other activities, such as job training, education, or caregiving, as satisfying the work requirements, though it will be up to each state to make that decision.
Verma argued that research shows having a job improves people’s health.
Joan Alker, executive director of the Georgetown Center for Children and Families, countered that the administration has the “causality backwards” and “you’re more likely to be able to work” if you have health insurance such as Medicaid in the first place.
Of the 9.8 million non-elderly Medicaid enrollees not working in 2016, 36 percent said illness or disability was their main reason for not working, according to the Kaiser Family Foundation. Thirty percent said they were caring for a family member, while 15 percent said they were going to school.
Verma said that in travelling the country, she finds that people want to get off Medicaid and get insurance elsewhere.
“They want to get off of public assistance,” she said. “They want to have a better life.”
Sen. Ron Wyden (D-Ore.), the top Democrat on the Senate Finance Committee, said in a statement that the vast majority of Medicaid enrollees either already have a job or “are unable to work due to age or impairment.”
“This action by the Trump administration goes after people who are just trying to get by while taking care of their kids or elderly parents, struggling with a chronic condition, or going to school,” Wyden said.