Trump poised to take action on Medicaid work requirements

The Trump administration is preparing to release guidelines soon for requiring Medicaid recipients to work, according to sources familiar with the plans, a major shift in the 50-year-old program.

The guidelines will set the conditions for allowing states to add work requirements to their Medicaid programs for the first time, putting a conservative twist on the health insurance program for the poor.

Democrats are gearing up for a fight, likely including lawsuits, arguing the administration is trying to undermine ObamaCare’s Medicaid expansion on its own after Congress failed to repeal the health-care law.

Democrats argue the changes would result in people losing health coverage if they cannot meet the new requirements or simply if the new bureaucratic hurdles discourage people from enrolling. They say many Medicaid enrollees already work, and those that don’t often can’t because they are disabled or caring for family members or other reasons.

“If they put out guidance, that would be a watershed moment I think,” said Hannah Katch, senior policy analyst at the left-leaning Center for Budget and Policy Priorities. It would be a “fundamental change in the way that people are covered by Medicaid,” she added.

Liberal groups are preparing to sue the administration over the changes, arguing that work requirements are not allowed under current law and would require congressional action. Waivers must promote the “objectives” of Medicaid to be approved under the law, and Democrats argue a change that could cause people to lose coverage fails that standard.

“The guidance is an attempt to put the administration’s preferred legal framing around the waiver approvals, in anticipation of likely legal challenge in the federal courts,” Fishman, who now works for Families USA, a liberal advocacy group, wrote in the email. “Given that the legal standard is whether the waivers ‘promote the objectives’ of the Medicaid program, that the basic objective of the program is to cover low-income people, and that these waivers will take coverage away from low-income people, they will have a tough legal case to make.”

Of the 9.8 million non-elderly Medicaid enrollees not working in 2016, 36 percent said illness or disability was their main reason for not working, according to the Kaiser Family Foundation. Thirty percent said they were caring for a family member, while 15 percent said they were going to school.

Experts at the Georgetown Center for Children and Families say that a significant number of people would lose coverage if a state imposed work requirements, in part simply due to red tape.

The center points out that Kentucky’s own estimates say 100,000 fewer people would have coverage by the fifth year of its proposal.

(Excerpted from The Hill 1/5/18