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Civil and Human Rights Coalition Condemns New Medicaid Work Requirements

12 January 2018

Her agency spelled out safeguards that states should put in place to get federal approval for their waivers.

"Medicaid needs to be more flexible so that states can best address the needs of this population", CMS Administrator Seema Verma said in a statement Thursday.

The waivers with work requirements will still see heavy political pushback, and there will probably be legal challenges. The program, funded jointly by the federal government and states, provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities. Medicaid was expanded under former President Barack Obama, with an option allowing states to cover millions more low-income adults.

While more than 74 million people are enrolled in Medicaid, only a small fraction would be affected by the work requirement. This time, the attack is adding unnecessary work requirements for Medicaid recipients.

Ten states - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, Mississippi, New Hampshire, Utah and Wisconsin, are now seeking work requirements for Medicaid recipients. "People moving off Medicaid is a good outcome; we hope it means they don't need the program any more".

Announcement of the new guidance delivers on the commitment made by Administrator Verma in her address to state Medicaid directors last November, to "turn the page" in the Medicaid program and give states more freedom to design innovative programs that achieve positive results for the people they serve and to remove bureaucratic barriers that block states from achieving this goal.

The conditions would exclude individuals eligible for Medicaid due to disability, elderly beneficiaries, children and pregnant women.

However, the Obama administration did not approve any state waivers that would impose work mandates, saying it was not in keeping with the program's mission to provide access to medical services.

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The administration said states must fully comply with federal disability and civil rights laws to accommodate disabled people and prevent those who are medically frail from being denied coverage.

The guidance cites research that it says demonstrates people who work tend to have higher incomes associated with longer life spans, while those who are unemployed are more prone to depression, "poorer general health", and even death.

Sixty percent of Medicaid's non-elderly adults already work, according to a recent analysis of census data by the Kaiser Family Foundation.

Among those who do not work, 36 percent report they are ill or disabled, 30 percent report they are taking care of an ill family member or friend, 15 percent say they are in school and 9 percent say they are retired. "The analysis noted that, 'More than one-third of those not working reported that illness or disability was the primary reason for not working. almost nine in ten (88%) non-SSI Medicaid adults who report not working due to illness or disability has a functional limitation, and more than two-thirds (67%) have two or more chronic conditions such as arthritis or asthma'".

In the end, Altman said, the change likely won't have a significant difference given that 59% of Medicaid recipients already work and those that don't are likely in the exempted categories.

The debate about work requirements doesn't break neatly along liberal-conservative lines.

Thursday's administration guidance to states spells out safeguards that states should consider in seeking work requirements.

States should try to align their Medicaid work requirements with similar conditions applying in other programs, such as food stamps.

Civil and Human Rights Coalition Condemns New Medicaid Work Requirements