Kentucky Is First To Get Federal OK For Medicaid Work Requirement

Some states will impose work requirements for Medicaid

A day after issuing guidance to state Medicaid directors announcing a new policy allowing states to condition Medicaid coverage on work, the Trump administration approved Kentucky's 1115 waiver, KY HEALTH, signaling the beginning a dramatic policy shift for the Medicaid program and a new direction for CMS.

The study also suggests that any reduction in payments associated with proposed cuts to the Children Health Insurance Program (CHIP), which operates in tandem with Medicaid in most states, could mean less access to care, said Brendan Saloner, a researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Kentucky also anticipates the most drastic drop in Medicaid enrollment out of the 10 states with pending work requirement waivers, according to by the Commonwealth Fund.

CMS also advised states to make work requirements for Medicaid similar than those used with food stamps to "reduce the burden on both states and beneficiaries". Reuters noted that decision to allow work requirements faces probable legal challenges. Officials in several other states have said they are interested in the idea.

New Hampshire is one of the states seeking to employ the new program. "What troubles me about the language I've seen so far [from CMS] is it seems to give states a wide berth to adopt policies that could hurt some people who are barely getting by".

It is unclear how enrollees will prove they meet such criteria or if states will use the honor system.

During a 1:30 news conference in Frankfort on Friday, Bevin called the plan "transformational", and said most human beings don't like to be wards of someone else.

Those who are exempted include children and former foster care kids, pregnant women, senior citizens, people who are the primary caretakers for a child or a disabled adult, those who are deemed medically frail or diagnosed with an acute medical condition that would prevent them from working, and full-time students. The federal government, however, leaves the qualifying characteristics up to states.

Before Verma joined CMS she was a private consultant and an architect of the Kentucky plan that was approved Friday. But in a speech to the nation's Medicaid directors in November, Verma said adding non-disabled adults to Medicaid was a mistake for a program created to help children, the disabled and pregnant women. If they don't, they'll have until a state-determined date to make up those hours.

ME is one of ten states asking for a waiver from the Federal Department of Health and Human Services. "They just said there are considerations...."

In its guidance to states, CMS said they should consider how some communities have high unemployment rates and whether enrollees need to care for young children and elderly families. About 52 million of the 74 million Medicaid enrollees rely on managed-care companies for their coverage. It says states must "take certain steps" to provide coverage for people in need of substance abuse treatment, potentially by counting time a person spends in treatment toward work requirements or by exempting those participating in "intensive medical treatment".

The new rule, to be rolled out in July, would mandate able-bodied Kentuckians on Medicaid to work or volunteer 20 hours per week. That leaves plenty of chances to fall through the cracks of a work requirement. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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