CMS Opens Path for Medicaid Work Requirements With Waivers

Kerry Dooley Young

January 11, 2018

The Trump administration has opened a path for states to add work requirements to their Medicaid programs, an approach that has both ardent critics and supporters.

The Centers for Medicare & Medicaid Services (CMS) announced today that it will support demonstration projects to test whether work requirements might "promote better mental, physical, and emotional health" for able-bodied adults enrolled in the program.

Medicaid currently covers about 68 million Americans who either have low incomes or disabilities. Requiring people on Medicaid to work or to engage in community activities such as volunteering might "help individuals and families rise out of poverty and attain independence," CMS said in a statement today.

"A 2013 Gallup poll found that unemployed Americans are more than twice as likely as those with full-time jobs to say they currently have or are being treated for depression," Brian Neale, director for the Center for Medicaid and CHIP Services, wrote in a 10-page letter to state Medicaid directors, which serves as guidance. "Other community engagement activities such as volunteering are also associated with improved health outcomes, and it can lead to paid employment."

The CMS guidance noted that many states already have systems in place for implementing work requirements, often in connection with the Temporary Assistance for Needy Families program and the Supplemental Nutrition Assistance Program, best known as welfare and food stamps. CMS suggested that future Medicaid community engagement or work requirements might be aligned with these existing programs to reduce administrative burden.

CMS Administrator Seema Verma used her official Twitter account today to bolster the case for Medicaid work requirements, citing research that links employment to health benefits. She noted that the agency's guidance on work requirements "only applies to able-bodied, working age adults and outlines protections for individuals determined to be medically frail or suffering from opioid addiction and other substance use disorders."

Verma, who previously served as a consultant for many state Medicaid programs, also emphasized that there's strong demand to test employment requirements in connection with the giant health program.

"As of today, 10 states have requested flexibility from CMS to incentivize #Medicaid beneficiaries to participate in community engagement activities, find work and achieve self-sufficiency," Verma tweeted.

Many Republicans in Congress have been pressing for states to attach work requirements to Medicaid. Still, even in the Trump administration, CMS appears to be moving cautiously on states' requests to incorporate work requirements into Medicaid programs.

In 2016, Kentucky submitted a Medicaid waiver application that included work requirements, seen as a bellwether for the Trump administration's view on compelling people enrolled in the program to seek employment. Kentucky last year revised the application; changes included a shift in its approach to mandating participation in community activities and employment.

Many comments submitted to CMS about the revised Kentucky waiver protested the proposed work requirement, noting that people enrolled in Medicaid often already work and may in fact hold several jobs. A work requirement could deprive people who are struggling economically from receiving healthcare, many people said in their comments. "Requiring volunteer work or other type of community engagement assumes individuals have no problems with transportation or childcare," one commenter wrote. "It also puts the burden of finding this type of work on individuals who are struggling to meet basic needs."

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