Medicaid Work Rules? Who is Impacted?

On January 11, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a letter to State Medicaid Directors regarding Opportunities to Promote Work and Community Engagement Among Medicaid Beneficiaries.[1]

Per CMS the policy is designed to help states improved Medicaid enrollee health and wellness through the process of providing incentives for work and community engagement for those enrollees who are not elderly, not pregnant adults who are eligible for Medicaid on a basis other than disability.

The state projects are considered demonstration projects and are authorized under section 1115(a) of the Social Security Act.  The state demonstration applications will be reviewed on a case-by-case basis.

Kentucky was the first state to successfully apply for the demonstration project and plans to begin implementation of the work requirements by region starting in July.[2]  Indiana was the second state to obtain federal approval to add a work requirement for adult Medicaid recipients who gained coverage under the Affordable Care Act.[3]

Per, as of February 1, 2018, nine states; Arkansas, Arizona, Indian, Kansas, Maine, Mississippi, New Hampshire, Utah and Wisconsin have pending waiver requests at CMS.  The basic premise is the requirement to work a certain number of hours per week in exchange for health coverage.

On Tuesday, February 13, 2018, the Virginia Senate voted to impose work requirements on the state’s one million Medicaid recipients.  The bill now moves to the Senate for a vote.  The summary of HB 338 is as follows:   

 “Medicaid; work requirement; report. Directs the Department of Medical Assistance Services (the Department) to apply for a waiver to implement a work requirement for able-bodied adult recipients of medical assistance services. The bill requires the Department to administer the Training, Education, Employment, and Opportunity Program (the Program) to enable Medicaid enrollees to improve their health and well-being through training, education, employment and other community engagement opportunities leading to self-sufficiency. The bill requires Medicaid recipients to participate in the program but provides exceptions for children, individuals age 65 or older, individuals with certain disabilities, and individuals who are the primary caregiver for a dependent.

The bill requires enrollees to meet gradually escalating participation requirements, culminating in 20 hours per week of required participation after 12 months of enrollment. The bill provides that the Program shall work with Virginia Workforce Centers or One-Stops to provide services to enrollees.”

Overall impact of the new rules is unknown, However, in Louisiana for example, 70% of Medicaid adults are already working and of the remaining 30% only a small part are not in the category of student, disable or family caretaker and able to work.[4]  Kaiser Family Foundation estimates that just 7% of the population will be affected.[5]