CMS to Test Medicaid Waiver "Community Engagement" Incentives

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For the first time ever, the administration is giving states the green light to seek waivers that would allow them to impose work or job training requirements on people who rely on Medicaid, the federal-state partnership program which provides largely free health care coverage to more than 70 million children, low-income Americans, the disabled, and the elderly.

"Medicaid needs to be more flexible so that states can best address the needs of this population", Verma said in a statement announcing an initiative that could affect millions.

The Centers for Medicare & Medicaid Services (CMS) rolled out guidance Thursday for states wishing to implement work requirements for Medicaid recipients, declaring that "helping Americans at or near the poverty line improve their lives. should be a cause that unites us all".

To date, CMS has received demonstration project proposals from 10 states that include employment and community engagement initiatives: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

Several Republican lawmakers have supported work requirements as a condition for Medicaid coverage for able-bodied people, but such changes were not allowed until Thursday's memo. He said it's not clear what problem a Medicaid work requirement would solve, and that there are better ways to help people find jobs or reduce the number of people receiving Medicaid.

The work requirements "could have negative implications on many who are working or exempt from the requirements".

Administrator Seema Verma, of the #trump administration, is passionate about the new Medicaid work requirements and feels that it is a positive change. The plan comes after months of failed negotiations on Capitol Hill to repeal and replace former President Barack Obama's landmark health care legislation. Consumer advocates and health policy experts fear that such a requirement could prove a big hurdle for many recipients, leaving them without the care they need.

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For instance, Kentucky a year ago proposed work requirements for able-bodied adults to get Medicaid insurance as well as new fees for all members based on income.

Mary Beth Musucemi, associate director of the Kaiser Family Foundation's Program on Medicaid and the Uninsured, said the new approach "will penalize individuals by having them lose health coverage, rather than incentivize them, as a voluntary program with adequately funded supportive services necessary to overcome barriers would".

Among adult Medicaid recipients between age 18 and 64, 60 percent already have jobs, according to the Kaiser Family Foundation health policy research group.

Most Republican legislative leaders are opposed to expansion, with some saying it is a non-starter, because of concerns that the federal government may not provide 90 percent of the annual administrative costs for the expansion.

"A$3 growing body of evidence suggests that targeting certain health determinants, including productive work and community engagement, may improve health outcomes" the letter says. "What she is in fact doing is promoting the hard bigotry of animus against poor people - the hard and shameful bigotry of health care denial based on wealth", Weissman concluded. The work requirements are part of the state's request to the federal government for an exception to contract out both physical and behavioral health to private companies. President Obama expanded the program by allowing states to cover millions more low-income adults. Recipients who meet the work requirements in the Supplemental Nutrition Assistance Program, commonly known as food stamps, and by the Temporary Assistance for Needy Families, must be considered in compliance with their state's Medicaid rules.

CMS said the new policy seeks to help improve the economic situation of Medicaid recipients.

"I don't know that that one change would make any sort of fundamental change", House Appropriations Chairman Nelson Dollar, R-Wake, said. In the end, that state included in its Medicaid expansion only an encouragement of voluntary efforts by beneficiaries to train for work or find jobs.

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