Emily Beauregard, executive director for Kentucky Voices for Health, an advocacy group, said one of the key exemption issues states must work out is defining who is "medically frail"- a designation that CMS said would exempt enrollees from the requirement.
It can scarcely be emphasized strongly enough that work requirements are a solution largely in search of a problem (unless the "problem" is that safety net programs exist at all, which is how a lot of people see it).
What's more, even if accepts the premise behind them, as a practical matter, such requirements are unnecessary.
"This marks the first significant change to a federal entitlement program in more than 20 years".
In sum, the Trump administration is targeting a poor population that's not exactly slacking off, and it's trying to drive more of them to work using a strategy that hasn't exactly proven effective.
"Rather than saving monies, the waiver creates new costs in expensive bureaucratic systems and reductions in the health of our workforce", Pugel added.
Yesterday the Trump Administration released proposed guidelines for those states that wish to impose work requirements on Medicaid recipients. All that said, lawmakers should also note that, even when it's implemented imperfectly, Medicaid can bring jobs across the state, help families become more financially stable as they avoid medical debt, and help them stay healthy so that they can contribute to their communities.
According to CMS, meeting work and community engagement requirements will take into consideration areas of high unemployment or caregiving for young children or elderly family members. "They want to develop programs that will help them break the chains of poverty and live up to their fullest potential".
But the Obama administration encouraged states to waive work TANF requirements, with the result that by 2015, 42 states had partially or completely waived them, and food stamp enrollment skyrocketed to almost 46 million (from 17 million in 2000). A study in December in JAMA Internal Medicine found that about half of the Medicaid recipients in MI were already working.
While revealing the administration's 2018 budget blueprint in May 2017, Office of Management and Budget (OMB) director Mick Mulvaney said that the administration's goal was to ultimately ween Americans off of welfare programs and put them back to work.
In a speech to state Medicaid officials in November, Verma indicated that the Trump administration would be receptive to adding work requirements and considering other conservative policy ideas to reshape Medicaid.
Verma, who worked with Kentucky and IN on their work requirement waivers as a health consultant before joining the Trump administration, recused herself from the decision on those states' waiver requests. And the proportion of doctors taking at least as many Medicaid as privately insured patients climbed nearly 6 percentage points to about 56 percent.
For the first time in the five-decade history of the Medicaid program, the federal Centers for Medicare and Medicaid Services will permit states to on Medicaid beneficiaries. So are the more than 10 million people on Medicaid because they have a disability.
"When you take all of these things together, it takes away from what the ACA [Affordable Care Act] was trying to do, which was a seamless way to get health coverage", says Kelly Whitener, associate professor at Georgetown University's Center for Children and Families.
The federal government has wide latitude to grant states such waivers. That means people who have jobs will have to prove it at regular intervals, and so will some people who are exempt for other reasons. Some people are - there's a question of whether people are unhealthy because they're not working, or are they unemployed because their poor health prevents them from working? Solomon estimates that fewer than 2 percent of the 74 million people covered would be directly affected by a work requirement.
In a call with reporters, state officials estimated that now, there are about 350,000 people across the commonwealth that will be impacted by the work requirements.