White House releases new Medicaid guidelines requiring work for coverage; Kentucky first to propose reform

In a first, the Trump administration has released new rules for Medicaid recipients which may soon oblige citizens covered by the federal health insurance program to find employment in order to retain their benefits.

Addressing the new guidelines issued on Friday, Jan. 12, Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), the government agency which oversees the program, said:

“Medicaid needs to be more flexible so that states can best address the needs of this population. Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries.”

Under the new White House plan, some Medicaid recipients can be required by states to obtain a job, perform community service or be enrolled in a job-training program to remain eligible to receive Medicaid benefits.

Adults between the ages of 19–64 are eligible to be required to work a total of 80 hours monthly to retain benefits.  The infirmed, primary caregivers, children and expectant mothers would not fall under the new guidelines.

Recipients could also be required to pay up to $15 monthly to keep Medicaid and includes a rewards system by which participation in health programs will earn basic dental and vision coverage.

Following the release of the new guidelines, Kentucky became the first to apply for the waiver to implement reforms. North Carolina, Arizona, Wisconsin, Indiana, Kansas, Arkansas, Utah, New Hampshire and Maine are reportedly also interested in seeking waivers from CMS.  

Additionally, some states are looking into including mandatory random drug testing, lifetime limits on benefits, minimum premiums and penalties for enrollees who fail to meet minimum requirements to remain covered.

Although CMS’ reforms may seem draconian, many red states are now considering legislative proposals to expand Medicaid as a result of allowing work requirements.

“Expanding does create the opportunity to cover more people, but if it’s done with things like work requirements, premiums and other similar policies we know reduce coverage, the gains won’t be as large,” said MaryBeth Musumeci of the Kaiser Family Foundation.

Responding on Wednesday, a group of 15 Medicaid recipients from Kentucky represented by three non-profit advocacy groups filed a federal lawsuit against the Trump administration, requesting a Washington, D.C., district court judge issue an injunction against the new CMS rules.

Kentucky state officials say they expect 95,000 to lose their Medicaid benefits over the next half a decade due to the reform.

Created in 1965, Medicaid is a jointly-administered federal and state program which defrays costs of healthcare services for lower-income individuals, including seniors, children, and pregnant women.


Editor’s note: This article was updated @ 3:02 p.m. EST.


[New York Times] [Politico] [Washington Post] [AP via Kentucky.com] [Photo courtesy The Fiscal Times]