Kentucky First to Set Medicaid Work Requirements


In a 10-page memo to state Medicaid directors, the Centers for Medicare and Medicaid Services said it would support states that want to set up such requirements and it provided guidelines for how to gain approval from the Trump administration.

Nine other states have asked the Trump administration for Medicaid work requirement waivers. People with disabilities, children, pregnant women and the elderly are exempt from the requirement.

Under Medicaid's new management, she says, the philosophy surrounding work requirements has changed.

Officials acknowledge that the work requirement - coupled with other changes in its waiver request - would lead to about 95,000 fewer people enrolled after five years.

The approval comes just one day after the Trump administration announced new guidance meant to encourage states to apply for such waivers, something that has never before happened in the 50-year history of the Medicaid program. In his 2012 majority opinion in NFIB v. Sebelius, U.S. Supreme Court Justice John Roberts affirmed this view, writing, "Under the Affordable Care Act, Medicaid is transformed into a program to meet the health care needs of the entire nonelderly population with income below 133 percent of the poverty level".

States would have the flexibility to identify activities other than employment that promote health and wellness and could include community service, caregiving or job training. More than 700,000 Mississippians receive Medicaid. She quoted from a speech President Lyndon Johnson gave a half-century ago, when he said that Medicaid's aim " is not only to relieve the symptoms of poverty but cure it". Matt Bevin said at a press conference announcing the waiver approval that he expects his state to "become the model of the nation". It's up to states to define that. With this data, money can be handed out to the poor in society, with the aim of bettering their health.

"Working doesn't make people healthy".

NPR health policy correspondent Alison Kodjak is with us now to talk about this.

Will Humble is the director of the Arizona Public Health Association and former Director of the state Health Department. It's seen one of the largest drops in its uninsured population under Obamacare, partly thanks to the state's use of the law's funding to expand Medicaid. So who is likely to be affected by these new rules? People who are working are going to have to prove it, so even people with jobs could stand to lose their insurance due to red tape. It also encourages an exemption for people who are deemed "medically frail". Or they're caring for a child or family member, or they're sick or disabled.

Such able-bodied adults were not eligible for Medicaid in New Hampshire prior to the 2014 expansion, which has led to an additional 50,000 enrollees. They also hearken back to the program's original intent, he added, "as temporary assistance to try to help people get back on their feet, not a permanent subsidy for someone's lifestyle, if they're capable of working". But Solomon says it's specifically prohibited under Medicaid law.

SARA ROSENBAUM: Or they're looking for work.

"We're really optimistic that we'll get official waiver approval very soon", she said.

KODJAK: Yeah. So actually, 10 states already have applied for these waivers.

KODJAK: It follows along with what we've been discussing. In some cases, they may have to file paperwork as often as every month to verify that they're still exempt. "The funding fairy doesn't just show up to pay for that-that is a taxpayer requirement". They also must complete a financial or health literacy course. And opponents are anxious that that's the problem.

The expansion allowed people to get covered if they earned 138 percent of FPL or less.

MCEVERS: NPR's health policy correspondent Alison Kodjak, thank you so much.