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Katiri Zuluaga

Manager, State Initiatives

Administration Continues Pushing for Medicaid Work Requirements

August 2, 2018 | ACA | Medicaid | Comments
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The Trump Administration intends to continue approving states’ requests to institute work requirements on Medicaid enrollees, despite a recent court ruling that set such efforts back. In an address last week, Health and Human Services (HHS) Secretary Alex Azar said the administration is ‘undeterred’ after a federal judge blocked Kentucky’s Medicaid work requirements last month. This move invalidated the Centers for Medicare and Medicaid Services’ (CMS) approval of an 1115 Medicaid waiver to redefine eligibility for the public program in Kentucky.

Secretary Azar also came out against Medicaid expansion under the Affordable Care Act (ACA), and correlated expansion with increased health care costs. Contrary to Secretary Azar’s statement, a recent study shows that Medicaid work requirements may impose significant administrative financial burdens on states, with Fitch Ratings reporting that Kentucky’s Medicaid administration costs increased more than 40% to support the now invalidated enactment of work requirements. Secretary Azar went on to express support for restructuring of the ACA through changes to age-rating rules and replacing the ACA with state block grants.

Kentucky was the first state to receive CMS approval for Medicaid work requirements in the 52-year existence of the program. Under the previously approved proposal, Kentucky would have required individuals who did not meet certain exemptions to engage in community engagement at least 20 hours per week or risk losing benefits. Following the district court’s ruling that CMS had not properly considered whether these requirements would violate Medicaid’s central objective of providing medical assistance to the state’s citizens, CMS is re-opening a public comment period to receive more feedback on potential Medicaid work requirements in the state.

Four states have received approval for the implementation of Medicaid work requirements to date: Kentucky, which has now been invalidated by the courts, Arkansas, Indiana and New Hampshire. There are currently seven other states who have submitted 1115 waivers including work requirements that are pending approval from CMS.

The National Council for Mental Wellbeing has strongly condemned work requirements and believes that work requirements not only make it harder for individuals with mental health or substance use disorders to receive the treatment they need, it is against the core mission of Medicaid.