Monday, 28 May, 2018

What Do Trump's Work Requirements for Medicaid Mean?

Seema Verma now administrator of the Centers for Medicare and Medicaid Services guided her home state of Indiana to expand Medicaid eligibility under the governor at the time Mike Pence while emphasizing Journal Times editorial: Work for benefits should be encouraged for those who are able
Preston Stone | 19 January, 2018, 01:35

"It has been long overdue". "The result will be a transformational improvement in the overall health of our people and will provide a model for other states to follow", Matt Bevin, the state's Republican governor, Friday.

Administration officials and their Kentucky counterparts have portrayed the plan as a way to improve the health of low-income residents and encourage self-sufficiency among poor but able-bodied adults. (The Obama administration denied such requests.) If the federal government gives approval, the states may make work activities a condition for Medicaid eligibility.

"Kentucky will soon be the unfortunate poster child of this unsafe policy", lamented Rep. John Yarmuth (D-KY). "And for those who are eligible for an exemption, the policy could still require someone who is medically frail, for example, to jump through administrative hoops to demonstrate that they are eligible for an exemption". It is an article of faith among many conservatives that federal safety net programs are abused by able-bodied Americans too lazy to work. Rather, that's the carrot he's offering the NCGA to finally expand Medicaid, which would help as many as a half-million North Carolinians access health care.

Kentucky is one of at least 10 states interested in the waiver with Arizona, Arkansas, Indiana, Kansas, Maine, Mississippi, New Hampshire, Utah, and Wisconsin all citing interest in the work requirement. That was the of any state in the country. And the public appeared to back this agenda: The Affordable Care Act polled terribly. By the end of 2015, almost two-thirds of the population reported a favorable view of the Medicaid expansion, and more than 70 percent said they would rather "keep the state's Medicaid program as it is today rather than change it to cover fewer people".

Bevin ran on an anti-Obamacare platform and, like President Trump, immediately set about reversing his Democratic predecessor's health care agenda when he took office.

Bevin's Medicaid changes take effect in July.

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The policy change is expected to result in 95,000 fewer Medicaid recipients after the five-year window granted by federal authorities, an aide to Bevin told The Washington Post. For people who may struggle with homelessness, drug addiction, mental health issues, poor English skills and the many other barriers to stability that come with being poor in America, such paperwork can be a bridge too far.

Leonardo Cuello, the director of health policy at the National Health Law Program, believes many of these provisions are subject to court challenges because they violate Congress' original intent for Medicaid and do not meet the waiver law's requirement that they consist of a novel policy experiment.

Anyone who does not pay their premiums or submit paperwork to show their eligibility would lose their coverage and would not be able to reapply for six months, although people who don't pay premiums could restore coverage by completing a financial literacy course (the details of which aren't yet clear). "So that's not an experiment". 'We know enough to know this can't be implemented in a way that protects people. "It's like saying, 'I want to experiment by running at full speed into a brick wall and seeing what will happen'".

"While work requirements are meant to promote work among those not working, coverage for those who are working could be at risk if beneficiaries face administrative obstacles in verifying their work status or documenting an exemption", KFF said.

"But here is the wonderful thing, what if it moves it for one individual or their children?" So it's particularly problematic in states like Kentucky where rural hospitals are already financially strapped.

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