New Trump Policy Will Allow States to Mandate Work Requirements for Medicaid Recipients

Centers for Medicare and Medicaid Services administrator Seema Verma (Image via AP)
Centers for Medicare and Medicaid Services administrator Seema Verma (Image via AP)

The Trump administration has made major headway toward allowing states to impose work requirements for Medicaid recipients, tying the two together for the first time in the program’s 52-year history.

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A new policy guidance from the Centers for Medicare and Medicaid Services says that states will be free to create programs that require Medicaid recipients to prove that they’re working, training for a job or volunteering—proof similar to what’s asked of Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) recipients.

CMS administrator Seema Verma painted the guidance as a helpful step to promote employment among able-bodied Americans, despite the fact that 60 percent of Medicaid’s non-elderly recipients already have jobs, according to a study by the Kaiser Family Foundation. Of those who do not work, more than a third are ill or disabled, 30 percent are caring for young children and 15 percent are in school.

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Asked about those whose coverage will likely be canceled as a result of the policy, Verma insisted that decreased enrollment would mean only that more people are finding coverage through their employers.

“People moving off of Medicaid is a good outcome because we hope that that means they don’t need the program anymore,” she said during a press call.

Brian Neale, director of the federal Medicaid office, added to the program’s insane pile of justifications by suggesting that Medicaid recipients are actually harming themselves by staying voluntarily locked away in their homes all day.

“Productive work and community engagement may improve health outcomes,” he said. “For example, higher earnings are positively correlated with longer lifespan.”

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Advocates have pointed out the obvious idiocy of that logic. Brad Woodhouse, campaign director of Protect Our Care, called the new policy “the latest salvo of the Trump administration’s war on health care.”

“A majority of adults covered by Medicaid who can work, do work—often two or three jobs in fields like the service industry that are less likely to offer insurance,” he said.

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Ten states so far have expressed interest in testing the work-for-Medicaid model, with proposals coming from Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. Of those, Kentucky will likely be the first to implement the new requirements.

Night blogger at Jezebel

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DISCUSSION

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Political Science isn't Rocket Science - Except when it is

“People moving off of Medicaid is a good outcome because we hope that that means they don’t need the program anymore,” she said during a press call.

Because hope is always what you want to ground major public policy changes in. Verma’s not an idiot - she knows what this will likely do in terms of driving up the rate of uninsured, especially since no funds for job training are attached to this change. She just doesn’t care.

As for the rest of the GOP I really don’t know if they have a clue what the face of Medicaid looks like. I actually became Medicaid eligible for a time while pursuing a PhD (my school’s idea of financial aid was to give you a stipend that could pay for food or housing but not both, and even with extra part time gigs I was below the line) and I know a number of people who work multiple jobs in the “gig” economy and still qualify. A lot of people with casual employment will have a hard time documenting their status and income and will likely be discouraged by yet another round of red tape from even trying. So it’s another step back towards pre-ACA days with the poorest people avoiding healthcare until they have to go the ER. Next up will be mandatory drug testing - “to help address opioid addiction” by making sure no one who’s addicted goes anywhere near public services voluntarily (and hence the numbers of people getting services goes down and they can declare victory through accounting.