The Centers for Medicare and Medicaid Services issued guidance making it easier for states to design and propose test programs that implement such requirements, according to a Reuters report. "The most vulnerable people are the ones who need Medicaid coverage the most, and they will lose it", Pavetti said.
States, for instance, could require non-disabled, working age recipients to work, volunteer, go to school or enter a job training program. This would exclude individuals eligible for Medicaid due to a disability, elderly beneficiaries, children, and pregnant women.
KFF expressed concerns about 1115 demonstrations with work requirements because the majority of Medicaid members not working said they have a major disability, while working Medicaid members could face other administrative obstacles in receiving benefits. But administration officials argue that the work requirements will strengthen the program and improve health outcomes by encouraging Americans to train for and seek out jobs. The plan comes after months of failed negotiations on Capitol Hill to repeal and replace former President Barack Obama's landmark health care legislation. The remaining 27 percent were not working, but two-thirds of them had a chronic mental or physical health condition, and one quarter of them said this condition interfered with their ability to function on a daily basis.
In a 10-page letter to state Medicaid directors, the agency issued guidance for states seeking such waivers.
"Health care is a right that shouldn't be contingent on the ideological agendas of politicians", said Sen.
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Critics say the rules could mean more Americans are left without health insurance.
Nearly 60% of working-age Medicaid recipients are in fact working full- or part-time jobs, according to a Kaiser Family Foundation study. She was an architect of Kentucky's waiver application once a Democratic governor who had eagerly embraced the ACA was succeeded by Matt Bevin, a Republican who campaigned on a pledge to reverse the program expansion there. States would be required to come up with ways to help beneficiaries meet the requirements and to help them find job training, as long as they use non-Medicaid funds to do so. "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'".
"We know that Republicans tend to think of Medicaid more as a welfare program, while Democrats tend to think of it as more of a health insurance program", said Diane Rowland, the Kaiser foundation's leading expert on the program. The broadening of Medicaid to low-income adults under Obamacare - roughly 11 million have gained coverage under the health reform law's Medicaid expansion provision - further spurred GOP efforts. States should try to align their Medicaid work requirements with similar conditions in other programs, such as food stamps and cash assistance.
The move is a major shift in policy, but not a surprise for the Trump administration.
But it makes suggestions for states as to what counts as work, including state work programs, job training, volunteering, or caring for a relative. "It will be interesting to see how states are going to make this work for people".