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12 January 2018, 03:22 | Damon Campbell
The Trump administration's move allows states to deny medicaid if an able-bodied adult doesn't have a job
The Trump administration will allow states to require able-bodied adults work to receive Medicaid, a major policy change that could affect millions of low-income Americans.
The Trump administration has announced it is offering a path for states that want to seek work requirements on Medicaid recipients.
"Medicaid needs to be more flexible so that states can best address the needs of this population", Seema Verma, the head of CMS, said in a statement.
Officials in Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin have sent proposals to the federal government, according to CMS.
The new policy is a response to numerous state test programs through Medicaid projects in which recipients participated in community engagement activities, including skills training, education, job search, volunteering and care giving. This would exclude individuals eligible for Medicaid due to a disability, elderly beneficiaries, children, and pregnant women.
People are not legally required to hold a job to be on Medicaid, but states traditionally can seek federal waivers to test new ideas for the program.
A Health Affairs analysis found that if work requirements were applied to Medicaid nationwide, 11 million enrollees would be at risk of losing coverage. The plan comes after months of failed negotiations on Capitol Hill to repeal and replace former President Barack Obama's landmark health care legislation.
For example, participants would have to follow protocols for routine physicals and screenings to improve their health if they have such conditions as diabetes, obesity, etc.
At least 10 states, led by Republicans, were awaiting federal permission to enforce the new work rules, according to the Washington Post.
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The Trump administration is paving the way for one of the biggest policy changes to USA health care in decades.
Opponents of the proposal say that it opens up the ability for at-risk patients to get denied access and will make it more hard for worthy recipients to get access to care.
"For those who can not find work, requiring unpaid volunteer work in exchange for health coverage is unconscionable legally and morally, recalling the days of work houses for the poor". About 80% of Medicaid enrollees under the age of 65 are already in working families; part of the reason is Obamacare's optional Medicaid expansion for working poor adults who don't have children (prior to the expansion, you often had to be poor and have kids in order to qualify for Medicaid).
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.
CMS declined to say how many people could be potentially impacted by the work requirements, saying it would depend how states designed the programs. States should ensure that career planning, job training, referral, and volunteering opportunities considered to meet the community engagement requirement, and job support services offered in connection with the requirement, take into account people's employability and potential contributions to the labor market.
Brian Neale, director of the federal Medicaid office, believes the new program will be greatly helpful for those involved.
Cuello said the argument that work promotes health is "totally contorted". He dismissed the agency's justification that unemployment makes people less healthy.
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