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Katiri Zuluaga

Manager, State Initiatives

CMS Administrator Encourages Work Requirements in Medicaid’s New Direction

November 16, 2017 | Medicaid | Waivers/SPAs | Comments
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Last week, the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma gave a speech that further elaborated on new guidelines and priorities for Medicaid waivers. The Administrator’s comments to State Medicaid Directors included encouraging states to submit Section 1115 waivers that include work requirements, using the term “community engagements” to describe work requirements for able-bodied adults.

The CMS Administrator emphasized her belief that “low expectations” created by a lack of work requirements conflict with Medicaid’s objectives and that working provides health benefits and preserves dignity in Medicaid beneficiaries’ lives. Notably, these types of requirements would hurt individuals with severe mental illness or substance use disorders who have physical or mental limitations that impede their ability to maintain consistent work. To date, eight states have submitted 1115 waivers including work requirements pending approval by CMS.

Additional New Guidance Presented

  • Flexibility for States: Administrator Verma emphasized Medicaid’s new vision to increase flexibility among states to propose new programs, reduce regulations and increase efficiency.
  • Medicaid and CHIP Scorecards: These new state-by-state scorecards will track and publish both state and federal outcomes to improve transparency and accountability for both programs.
  • Increased Support for Section 1115 Demonstrations: CMS has published new content to its website – – highlighting increased flexibility for states to adopt budget neutral Medicaid reform pilot projects.

For more information on changes to 1115 waivers, State Plan Amendments (SPAs) and section 1915 waivers click here. To read Administrator Verma’s full comments click here.