States can require Medicaid recipients to work, Trump administration says

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"We see people moving off of Medicaid as a good outcome", she said. "It's making people healthier that enables them to work", he said. In total, Medicaid covers about 1.4 million people in the commonwealth.

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

"Medicaid needs to be more flexible so that states can best address the needs of this population. It is no longer a program to care for the neediest among us, but rather an element of a comprehensive national plan to provide universal health insurance coverage".

(A waiver for Kentucky, also an expansion state, has just been approved.) Of the other states that did not expand Medicaid, the new policy would, in some cases, add to administrative burdens without affecting work incentives for anyone except a relative handful of non-disabled adults. "Implementing co-pay and employment hurdles will increase administration costs and will inadvertently reduce access to health care for consumers in great need".

States are still awaiting formal approval of their requests. Though aides to the Kentucky governor estimate about half of the state's working-age and able-bodied Medicaid recipients will already meet the new requirements. And you know, the dollars and cents, you know - people know this is going to take money to build this out, to track work requirements. They include Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

But congressional Democrats said the Trump administration is moving in the wrong direction. Ron Wyden of Oregon.

The debate about work requirements doesn't break neatly along liberal-conservative lines.

For those who missed it - and given what a big week it's been for abusing the country's most vulnerable, from Salvadorans who have lived in the US for more than a decade and now face deportation to hospital patients kicked to the curb in Baltimore, not to mention hearing how a president describes Haiti and African countries in the most vulgar of terms, that's understandable - but the Woodlawn-based Centers for Medicare and Medicaid Services released guidelines that open the door to allowing states to impose work requirements on Medicaid recipients. Some 60% of non-disabled, working-age adults have jobs, while almost 80% live in families with at least one member in the labor force, according to a Kaiser Family Foundation analysis. It is the nation's largest health insurance program.

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Thursday's administration guidance spells out safeguards that states should consider in seeking work requirements.

—Taking into account hardships for people in areas with high unemployment, or for people caring for children or elderly relatives. That could mean counting time spent in drug treatment as a form of "community engagement". In a letter released Friday, CMS Principal Deputy Administrator Demetrios L. Kouzoukas outlines groups exempt from the requirements: former foster care youth, pregnant women, primary caregivers of a dependent, the medically frail, full-time students, and those diagnosed with an acute medical condition that would prevent them from complying with requirements. It has begun calling upon states to encourage adults that do not have children and those with no disability to work or so that they can get Medicaid.

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

Trump's new direction can be reversed by a future administration.

They estimate the changes will save about $2.4 billion over five years. The administration says the impact will be closely evaluated.

Bevin, a Republican, said the decision stemmed from concern about public health.

But people rarely make them because someone else forced them to.

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