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Trump Administration Overhauls Policy on Medicaid Work Requirement

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The Trump administration announced last week what experts are calling a “pivotal change” in the nation’s Medicaid program. For the first time the federal government is planning to allow individual states to establish a work requirement for some able-bodied Medicaid recipients.

There have been a plethora of articles about this policy changed ever since it was first announced by administration officials at the Centers for Medicare and Medicaid Services, known by the initials CMS. This one, for example, appeared last week on the website of Kaiser Health News. According to Kaiser, “Adding a work requirement to Medicaid would mark one of the biggest changes to the program since its inception in 1966.” But make no mistake, the article adds – this policy change is controversial. “It is likely to prompt a lawsuit from patient advocacy groups, which claim the requirement is inconsistent with Medicaid’s objectives and would require an act of Congress” to implement.

Another related article, this one from USAToday, called the new approach to a Medicaid work requirement “a first step toward a longstanding GOP goal of overhauling the program serving low-income Americans.” Under the Affordable Care Act, better known as Obamacare, millions of “able-bodied” adults became eligible for Medicaid coverage, something formerly limited to children, the elderly, and qualified disabled Americans.  Several states had asked the Obama Administration for permission to include a work requirement for Medicaid beneficiaries who were able to hold a job, but these states were not allowed to do so. One of the first states to act under the newly announced rules, according to the Kaiser article, is Kentucky, a state “which has some of the poorest counties in the country [and which] has seen its Medicaid enrollment double in the past three years” under the expanded Obamacare eligibility. Kentucky wants to require able-bodied adults on Medicaid (those without dependents) to work at least 20 hours per week.

The articles point out that over 74 million people are enrolled in Medicaid, yet only a small fraction would be affected by the work requirement. Nearly half of Medicaid enrollees are children, all of whom are exempt, as are the more than 10 million people on Medicaid due to disability. The regulations also apply only to “working age” adults, so seniors need not worry about the work requirement. According to the USA Today article, “A study from the nonpartisan Kaiser Family Foundation found nearly 60 percent of working-age adults on Medicaid work either full time or part time, mostly for employers that don’t offer health insurance. Most who are not working report reasons such as illness, caring for a family member or going to school.”

Officials in states advocating Medicaid work requirements were quick to point out the benefits. “Whether it is a job, training, volunteering, substance abuse treatment, additional education or another opportunity, becoming an active and productive member of the community is an important part of healthy living,” said one Indiana official. The CMS rules are promoting a fairly broad definition of “work” including skills training, education, job search, volunteering or care giving.  Part of the goal is to make Medicaid more flexible, says CMS, and hopefully to help some younger beneficiaries leave the program either by getting jobs with health care benefits or by earning enough to purchase health insurance on the open market. According to the Kaiser Health News article, Medicaid work requirements for able-bodied working age adults are widely popular, supported by 70 percent of Americans surveyed.

But various advocacy groups oppose the requirement. Some argue that CMS lacks the authority to change the Medicaid law without Congressional action, while others calls these requirements “harsh” and a “major obstacle” to the needy gaining coverage. Jane Perkins, legal director for the National Health Law Program, labeled the work requirement “a problem because it is not consistent with Medicaid’s objectives” to furnish medical assistance. She fears that establishing work requirements will “penalize [beneficiaries] by stopping health insurance or blocking them from getting health coverage in the first place.”

At AgingOptions we feel it is vital for our radio listeners, seminar guests and blog readers to know about some of these issues, not necessarily because the proposed work requirement will affect them directly, but because of what it says about the underlying strength – or lack of it –in the Medicaid program. In 2016 Medicaid’s total costs exceeded $553 billion for a program that covers roughly one American in five, so this program is vital to the health security of tens of millions of people.  While we don’t believe that Medicaid is going away any time soon, we do believe that it is imperative for people to become better informed about the health care choices that they will face in retirement and about the fiscal health of the programs many of us will one day depend on.

There is no better, faster way to get “up to speed” about a wide range of retirement-related issues – including Medicaid – than by attending an AgingOptions LifePlanning Seminar featuring Rajiv Nagaich. There you’ll learn how crucial decisions such as those involving health care (and eventually long-term care) cannot be made in a vacuum but must be considered as part of a total plan in which medical, financial, legal, housing and family issues are all woven together interdependently. This is the secret behind an AgingOptions LifePlan. Why not take the next step and invest a few hours to learn more?  Join Rajiv Nagaich at a seminar that is convenient for you. You’ll find all the details here including a calendar of upcoming seminars; then register online or contact us directly.

On any complex journey you need a good, experienced guide. Let Rajiv Nagaich and the term at AgingOptions serve in that capacity for you. Age on!

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