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Cooper and Trump together on Medicaid? Not so fast

12 January 2018

The Trump administration Thursday offered a roadmap for states seeking federal backing for waivers imposing the work requirements on the low-income adults in the Medicaid program.

The major policy shift seeks to overhaul the long-standing social contract between state and federal governments and poor citizens who rely on their services.

More than 4 in 10 adults with Medicaid coverage already work full time, and most others either go to school, take care of a relative or are too sick to work.

If Republicans truly cared about punishing "lazy" individuals soaking up money without having to work for it, they would be focusing their attention on "the idle rich", argued the Washington Post's Elizabeth Bruenig in a recent column.

The Centers for Medicare and Medicaid Services (CMMS) issued guidance making it easier for states to design and propose test programs that implement such requirements.

Other states to receive approval are Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, Utah and Wisconsin. The agency is expected to start approving state waivers promoting "community engagement activities" in coming weeks.

If the price of expansion is backing a requirement most people already meet, "Oh, please don't throw me in that briar patch", Venable said.

Public Citizen agreed, calling the idea of work requirements "cruel, stupid and illegal".

She quoted from a speech President Lyndon Johnson gave a half-century ago, when he said that Medicaid's aim " is not only to relieve the symptoms of poverty but cure it".


The plan will likely face a political battle, which could lead to legal challenges for the Trump administration over concerns that people would lose their Medicaid health care coverage.

The Governor's Office billed its willingness Thursday on expansion work requirements, a policy many other Democrats reject, as a pragmatic bid toward compromise. Requiring recipients to work would be illegal because it is not consistent with Medicaid's objectives, said Leonardo Cuello, health policy director of the National Health Law Program.

As of October 2017, almost 75m individuals were enrolled in Medicaid and the children's health insurance program (Chip).

"President Trump ended 2017 by giving the wealthiest Americans an enormous tax cut that will be paid for by low- and middle-income families, and is starting 2018 by continuing his attack on vulnerable populations".

A study by the nonpartisan Kaiser Family Foundation found that nearly 60% of working-age Medicaid recipients are already employed full time or part time. "A strong Medicaid program. does more than just provide [beneficiaries] a card".

Advocates for low-income people said work has never been a requirement for Medicaid, a program originally intended as a health program for the poor and disabled.

CMS today announced new guidance that will support state efforts to improve Medicaid enrollee health outcomes by incentivizing community engagement among able-bodied, working-age Medicaid beneficiaries.

Children account for more than two-fifths of those enrolled, with seniors or persons with disabilities accounting for an additional one-fifth, according to the Center on Budget and Policy Priorities. "Each state is different", the letter says, and such activities "include, but are not limited to, community service, caregiving, education, job training, and substance use disorder treatment".

Verma also had a major role in designing an unorthodox approach to Medicaid in IN, which had asked the Obama administration to approve a work requirement.

Cooper and Trump together on Medicaid? Not so fast