The Trump administration's Medicaid announcement isn't really about 'work'

FILE- Gov. Charlie Baker listens as Health and Human Services Secretary Marylou Sudders speaks during a news conference on Tuesday

Gov. Charlie Baker's top health official said it's unlikely the administration will seek a waiver to establish work requirements for Medicaid recipients after President Trump opened the door to the major policy shift this morning. Over 70 million Americans are now enrolled in Medicaid, which provides health insurance for low-income individuals who are otherwise unable to receive benefits.

Expansion was a key part of the Affordable Care Act, the idea being it would extend the federal- and state-financed program to the working poor - people who make too much money to qualify for Medicaid but don't get insurance through work or make enough money to qualify for federally subsidized insurance plans through the online exchanges set up under the ACA, often called "Obamacare".

Seema Verma, head of the Centers for Medicare and Medicaid Services, said requiring work or community involvement can make a positive difference in people's lives and in their health. 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.

Instead of requiring states to increase and strengthen coverage, C.M.S. will now allow them to use waivers to promote "upward mobility" or "responsible decision-making". Yet the Centers for Medicare & Medicaid Services will likely soon allow Kentucky and IN to charge premiums to poor adults and cut off their coverage or charge them more to get care if they don't pay - and to cut them off if they're not working.

While more than 74 million people are enrolled in Medicaid, only a small fraction would be affected by the work requirement.

MaryBeth Musumeci, an associate director for the Program on Medicaid and the Uninsured at the Washington-based Kaiser Family Foundation, a health policy think tank, said the red tape will be a barrier to health care.

On March 14, 2017, the Department of Health and Human Services and CMS issued a letter to the nation's governors affirming the federal government's partnership with states to improve the integrity and effectiveness of the Medicaid program for low-income people with Medicaid. As the Kaiser Family Foundation notes, very few state agencies now have the capacity to develop and provide work support programs on their own.

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. In addition to traditional work and job training, engagement could include caring for a child or elderly parent, seeking treatment for drug addiction or going to school.

"Our arrangement direction was because of states that approached us for the adaptability they have to enhance their projects and to help individuals in accomplishing more noteworthy prosperity and independence", Verma said in an announcement. The main impact of the rules will be to subject poor people to stacks of paperwork that will drive some to drop coverage, the critics say.

"He wants Medicaid recipients to be healthy and to be able to work, but he does not believe that working should be a condition for receiving federal assistance", spokesman Sawyer Hackett said in an email. "They want to develop programs that will help them break the chains of poverty and live up to their fullest potential".

Verma, who worked with Kentucky and IN on their work requirement waivers as a health consultant before joining the Trump administration, recused herself from the decision on those states' waiver requests. Most who are not report reasons such as illness, caring for a family member or attending college.

The agency is encouraging states to align their Medicaid work requirements with those mandated by other federal safety net programs. "It would only apply to the ten or so states run by far-right Republicans who have asked to do this".

"A vast majority of them already work", he said. "That is what is best for the people of ME and the future of our state".

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