Published: Sat, January 13, 2018
Global News | By Stacy Ballard

Kentucky Is the First State to Enact Medicaid Work Requirements

Kentucky Is the First State to Enact Medicaid Work Requirements

As the governor himself stated in the waiver application, a full third of Kentucky's population is on Medicaid, and a main goal of the new work requirement and other restrictions is to cut down that number.

Milliman, an Indianapolis-based actuarial firm hired by the state to evaluate its program, predicts just under 133,000 Hoosiers on the state's Medicaid expansion HIP 2.0 would be subject to the work requirement.

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Several Republican lawmakers have supported work requirements as a condition for Medicaid coverage for able-bodied people, but such changes were not allowed until Thursday's memo. "Those days are over".

But if states want to do this, there is no reason the federal government should tell them they can't.

Bevin said the Medicaid overhaul was "long overdue" because it had devolved into a system that provides the benefit to people for whom it was not intended.

In its 10-page letter released Thursday approving work or volunteer requirements, the agency acknowledged its approval is a shift from past policy.

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In its guidance to states, CMS said they should consider how some communities have high unemployment rates and whether enrollees need to care for young children and elderly families.

Bevin has said that the system can not continue as it has because it costs too much, ignores private market dynamics and fails to prepare Kentuckians for self-sufficiency.

The state also has proposed moving about 60,000 people off Arkansas Works by limiting eligibility to people with incomes of up to the poverty level, instead of 138 percent of the poverty level.

The Trump administration will allow states for the first time to impose work requirements on Medicaid recipients.

Conservatives around the country, however, hailed the change to the federal-state program for low-income people. Kevin de León, a Democrat and the leader of California's Senate, wouldn't comment on the proposal because he said it's a non-starter.

Dustin Pugel, policy analyst with the Kentucky Center for Economic Policy, said Friday the change will reverse "the historic progress" Kentucky made in health care over the past two years.

The new guidance from CMS, however, says many Medicaid beneficiaries should be exempt from work requirements: That includes children, people with disabilities and people in treatment for substance abuse disorders. Those 80 hours can be from a job, volunteer work or job training.

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Almost 20 percent of the population received Medicaid benefits in 2015, according to the United States census. National evidence suggests that those who are unemployed and have significant health issues find the lack of coverage inhibits searching for or maintaining employment. According to his own administration, the work requirements will result in 95,000 fewer people on Kentucky's Medicaid rolls. It also encourages an exemption for people who are deemed "medically frail".

It's a "large and sharp reversal" from Medicaid in the past, says Judith Solomon, vice president of health policy at the Center on Budget and Policy Priorities.

Rep. Frank Pallone, D-N.J., said "the Trump administration's action today is cruel and a clear violation of both the Medicaid statute and long-standing congressional intent" for waivers, which he said were meant to "allow states to expand access to Medicaid, not restrict it".

But Medicaid payment for pediatric primary care services averaged 64 percent of payment from Medicare and 53 percent of payment from private insurance before 2013, when Medicaid payments were raised as part of the Patient Protection and Affordable Care Act.

Expanding access to health care would help alleviate the opioid crisis and create 15,000 jobs in hospitals and clinics, the center said. The failed efforts in the House to replace Obamacare included a work requirement for Medicaid.

"I don't think our approach is punitive, nor should it be".

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