Work Requirements for Medicaid Approved In Kentucky, More States to Follow


Kentucky Governor Matt Bevin

The Trump administration recently approved a waiver request from the state of Kentucky to begin imposing a work mandate for Medicaid recipients. It is the first state to receive such approval since the Obamacare Medicaid expansion.

The federal Centers for Medicare and Medicaid Services announced on 1/13/18 that it had approved a waiver submitted by the state’s Republican Gov. Matt Bevin to bypass restrictions on imposing work requirements for “able-bodied” people on Medicaid. “Why should a working-age person not be expected to do something in exchange for what they are provided?” Bevin said.

The approval will allow the state to begin enforcing a requirement for adults aged 19-64 to complete 80 hours a month of community engagement, which is defined as working either full-time or part-time, looking for a job, taking classes, or performing community service. Bevin's office said the new rules only apply to the expanded Medicaid population, or about 350,000 Kentuckians, about half of whom already have jobs. But there are many exemptions. The work requirements will not apply to pregnant women, full-time students, former foster care youth, primary caregivers of children and the elderly and full-time students. The work requirements also do not apply to anyone designated "medically frail," a broad term that includes people suffering from alcohol or drug addiction in a state that has been among the hardest hit by the opioid crisis.

Under current law, states cannot impose a work requirement as a condition of Medicaid eligibility. ObamaCare allowed states to expand Medicaid coverage and granted funding to people earning up to 138% of the federal poverty level. While the Obama administration was willing to be fairly flexible in what policies they allowed in expansion states, so long as the state ended up expanding coverage, they drew the line at work requirements. Only through a special waiver process can states gain approval to begin imposing these requirements. Nine other states have submitted waivers since the Trump administration signaled it would be willing to approve them where the Obama administration had denied them, with all but one ran by Republican governors.

The news is a victory for conservatives, who have long fought to curb fraud and promote a sense of dignity among Medicaid recipients. "There is dignity associated with earning the value of something that you receive," Kentucky Gov. Matt Bevin said. "The vast majority of men and women, able-bodied men and women ... they want the dignity associated with being able to earn and have engagement."

Republicans also say work and other requirements will return Medicaid to its original intent — to act as a stopgap until people can find work. They say it has expanded far beyond its basic mission. Trump administration officials said on Thursday that work requirements were consistent with the goals of Medicaid because work and work-related activities could improve the health of Medicaid beneficiaries. “Productive work and community engagement may improve health outcomes,” Brian Neale, the director of the federal Medicaid office, said on Thursday in a letter to state Medicaid directors. “For example, higher earnings are positively correlated with longer lifespan.”

Critics suggest work requirements will become one more hoop for low-income people to jump through, and many could be denied needed coverage because of technicalities and challenging new paperwork. Lawsuits are expected as individual states roll out work requirements. But Seema Verma, the administrator of the federal Centers for Medicare and Medicaid Services, said it best: “Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration. Those days are over.”

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