For the first time, states will be allowed to move toward requiring some Medicaid recipients to work to receive benefits, under new guidelines issued by President Donald Trump's administration Thursday.
CMS also encourages states to consider a range of activities that could satisfy work and community engagement requirements. But she said a work requirement hasn't been on her radar "because I've been completely focused on restructuring the Medicaid program and making it sustainable for MA".
Under the rules, states can require Medicaid beneficiaries to work, volunteer or participate in job training. The guidance also includes caregiving as one of the activities.
"Medicaid needs to be more flexible so that states can best address the needs of this population".
CMS will support state efforts to align Medicaid work and community engagement requirements with SNAP or TANF requirements, where appropriate, as part of this demonstration opportunity. They fear many recipients will be unable to meet the mandate and be left uninsured.
But work requirements have strong public backing.
The agency's guidance provides states with a lot of flexibility in designing their programs and highlights that many recipients may need additional considerations. The requirement would not apply to some participants, including pregnant women, those being treated for substance abuse, "the medically frail" and those older than 60. These modifications may include counting time spent in medical treatment toward an individual's community engagement requirements or exempting individuals participating in intensive inpatient or outpatient medical treatment, as well as supporting other state efforts. Republicans have tried repeatedly to overturn the health law.
But it makes suggestions for states as to what counts as work, including state work programs, job training, volunteering, or caring for a relative.
At least 10 states, led by Republicans, were awaiting federal permission to enforce the new work rules, according to the Washington Post.
CMS also advised states to make work requirements for Medicaid similar than those used with food stamps to "reduce the burden on both states and beneficiaries".
The state's Medicaid department is already in the process of applying for a waiver to add work requirements, which was part of the budget passed past year.
Under former president Barack Obama's Affordable Care Act, known as Obamacare, 31 states expanded Medicaid coverage.
The Obama administration turned down several state requests to add a work requirement.
Calling the new policy "unconscionable and illegal", Eliot Fishman, senior health policy director at the liberal consumer health lobby Families USA, said in a statement: "Today's announcement isn't about work".
Trump's new direction can be reversed by a future administration. So are the more than 10 million people on Medicaid because they have a disability. "They want to develop programs that will help them break the chains of poverty and live up to their fullest potential".
It found that almost half of them already work, and that 11 percent were unable to work.
The Centers for Medicare and Medicaid Services released guidelines Wednesday allowing states to implement work requirements for Medicaid. Now, she is in a position to approve them. "We see people moving off of Medicaid as a good outcome", she said. "Those days are over".
Most who are not working report reasons such as illness, caring for a family member or going to school.
In the states that adopt such requirements, critics say, the effect will spread far beyond the healthy adults who do not already comply. They could find it difficult to apply for exempt status and verify it, which may need to be done monthly in some states, while those who are working may have a hard time verifying their hours, especially if they have variable shifts.
Because Medicaid is a government-financed health insurance program with shared expenses between the state and federal governments, the U.S. Centers for Medicare and Medicaid Services has to agree to enact such work requirements.