According to Callow, the new policy chips away at the entitlement structure of the Medicaid program, which could result in vulnerable people losing their benefits, as well as a weakening of the program in Medicaid expansion states.
The policy responds to numerous state requests to test programs through Medicaid demonstration projects under which work or participation in other community engagement activities - including skills training, education, job search, volunteering or caregiving - would be a condition for Medicaid eligibility for able-bodied, working-age adults. Before enforcing those requirements, states must receive a waiver from CMS.
Under federal law, Medicaid waivers have to support the program's objectives by increasing coverage or health outcomes for people on Medicaid. Estimated spending on the program will be just under $27 billion this year, making it the fifth-largest program in the nation in terms of spending. Any state wanting to add a work requirement would still have to petition the CMS.
The Trump administration has rejected that logic.
Former President Obama, under the Affordable Care Act, allowed states to expand the program to include low-income adults who have jobs that don't provide health insurance.
In Kentucky, which expanded Medicaid, Republican state Sen.
"My only hope is that the chaos caused by this policy and the desperation of the Kentucky families who will soon lose their only access to health coverage will force Gov. Bevin to demonstrate some level of compassion and reverse this disgraceful policy", Yarmuth said.
Advocates for low-income people said work has never been a requirement for Medicaid, a program originally intended as a health program for the poor and disabled. The Kaiser Family Foundation estimates that there are almost 25 million non-elderly adults on Medicaid who are not on disability insurance. States will be required to offer reasonable modifications to individuals with disabilities, and will be required to exempt individuals determined to be medically frail or who have an acute condition that a medical professional has determined will prevent them from complying with the requirements. But a closer look reveals that many of those people face obstacles to entering the workforce. Among those who didn't work, one-third said illness or disability was the primary reason. Two-thirds of Medicaid recipients in MI who are "out of work" say they have a chronic illness.
The federal government and states generally share the cost of Medicaid and could save money if enrollment goes down because of work requirements. A comprehensive study of 11 mandatory work programs found that only two decreased poverty. States will therefore be required to describe strategies to assist eligible individuals in meeting work and community engagement requirements and to link individuals to additional resources for job training, provided they do not use federal Medicaid funding to finance these services.
That's why it's important that we expose the argument for work requirements for what it actually is - an attempt to perpetuate myths that stereotype people of color and stigmatize popular public programs that opponents simply don't like.
In those states that receive a waiver for the work requirements, those now working will be required to provide documentation that they are working, and those who are not will be required to prove that they should be exempted. But Neale made clear that states are in the "best position to determine which approaches are most likely to succeed".
Some Democrats and advocacy groups have said they would sue to block any new work requirement plans that CMS approves, Politico reported.
Thursday's administration guidance to states spells out safeguards that states should consider in seeking work requirements.
The guidance represents a fundamental and much-disputed recalibration of the compact between the government and poor Americans for whom Medicaid coverage provides a crucial pathway to health care.
"It seems to me they're saying some people will either mess up and not submit their hours and income within the 10-day time frame, they won't meet the 20 hours - they'll come up shy - won't meet the premium payment or say, 'You know what, it's not worth it, '" said Dustin Pugel, a policy analyst at the nonpartisan Kentucky Center for Economic Policy, a state-based think tank. In a press call on Thursday, she said that it is a good thing if people leave Medicaid and find coverage through employers.