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. Currently, Medicaid covers more than 70 million people, or about 1 in 5 Americans.
Kentucky has just received approval from the Trump administration to implement their work requirements, which mirror their requirements for food stamps. There are several changes to the program, the bulk of which are directed at people in the Medicaid expansion population and "able-bodied" adults who make under 100 percent of the poverty limit.
"We know that Republicans tend to think of Medicaid more as a welfare program, while Democrats tend to think of it as more of a health insurance program", said Diane Rowland, the Kaiser foundation's leading expert on the program. Parents with children younger than six would be exempted, as would people who can get a medical certification that they are unable to work. Critics say the requirement will be expensive to administer, provide an unnecessary barrier to coverage and penalize people who can't work due to undiagnosed medical problems.In Kentucky, for instance, the new restrictions are projected to cause almost 100,000 people to lose Medicaid coverage, according to the Kentucky Center for Economic Policy, which studies how state policies affect working-class families. They are: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. Lawsuits are expected as individual states roll out work requirements.
But the electoral dynamics in those states are very different than in Kentucky.
"Gov. Bevin has consistently said since submitting the 1115 application that these are the terms under which Kentucky will maintain expanded Medicaid", Maglinger wrote in the statement. For instance, some employees will receive a better plan and spend less overall by obtaining an insurance plan under the Affordable Care Act (ACA) healthcare marketplace or other alternative governmental related programs rather than paying into a company-sponsored ACA compliant plan. Another 36 percent report being too sick or disabled to work, though they haven't qualified for disability benefits.
Particularly harmful for Kentucky, Cuello said, is the provision ending the three-month retroactive coverage to which Medicaid recipients are usually entitled. That's far from certain.
Senate Majority Leader Mitch McConnell praised the changes, calling it "common-sense steps to engage patients, improve health, and reduce the burden on Kentucky taxpayers". By the end of 2016, the state was tied with West Virginia for the biggest percentage increase in health coverage. Polling last week by Hart Research Associates showed health care tops the economy, taxes, immigration and terrorism as a voter priority in the 2018 congressional elections. "So I'm afraid the administration is not only going backward, but doing it for completely the wrong reasons".
Though CMS attempts to clear the way for mandatory work requirements by claiming that "working promotes good health", the evidence overwhelmingly suggests that work requirements that force people off of public benefits "are more likely to harm their health and well-being" than to positively contribute to their climbing out of poverty.
The Kaiser Family Foundation found that 78 percent of Medicaid beneficiaries nationally are now working and that work requirements may just add unnecessary barriers for individuals seeking Medicaid coverage and benefits. In addition, 28 percent reported care-taking obligations, while 18 percent couldn't work because they were in school. 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.