Work in exchange for Medicaid coming to some states; Iowa to review

Iowa, which has not requested the change, plans to review the guidelines

Seema Verma testifies in February 2017 at her confirmation hearing to lead the U.S. Centers for Medicare and Medicaid Services. (Pete Marovich/Bloomberg)
Seema Verma testifies in February 2017 at her confirmation hearing to lead the U.S. Centers for Medicare and Medicaid Services. (Pete Marovich/Bloomberg)

WASHINGTON — The Trump administration cleared the way Thursday for states to impose work requirements on many Americans who depend on Medicaid, the mammoth government health insurance program for the poor.

The much-anticipated move — which was condemned by patient advocates, physicians and consumer groups — would mark the first time in the program’s half-century history that the government will require able-bodied people to work in exchange for health coverage.

The new plan sets the stage for a potentially long and contentious legal battle over the shape and purpose of a health program that more than 70 million Americans now depend on.

In Iowa, there are 600,000 Medicaid recipients, about 40 percent of whom are aged between 22 to 64, according to the latest quarterly report from the state Department of Human Services.

Human Services spokesman Matt Highland said Thursday the department, “in consultation with the administration, will take a look at the new guidance.”

But he indicated the state has its hands full for now dealing with other Medicaid issues.

Not only does it have a new Medicaid director, but the state is searching for at least one other company to help manage its privatized system, which has been coming under sharp criticism.

“Right now the department is focused on the recent transition, the recruitment of an additional (managed-care organization) and overall operational improvements,” Highland said in an email.


GOP Gov. Kim Reynolds, too, did not immediately embrace the idea but instead planned to review and consider it.

“The governor believes that Medicaid is an important safety net for many Iowans, and her hope is that those on the program who are able-bodied are able to find a career and re-enter the workforce,” spokeswoman Brenna Smith said in an email, pivoting to the governor’s priority of job training. “That’s why the governor is introducing the Future Ready Iowa Act, which will provide scholarship and grant dollars for Iowans who want to receive training in high demand fields.”

The Trump administration outlined the plan in a letter to state officials indicating the administration’s willingness to grant state requests for imposing job requirements on working-age, nondisabled beneficiaries.

“Medicaid needs to be more flexible so that states can best address the needs of this population,” said Seema Verma, who oversees the Medicare and Medicaid programs at the U.S. Department of Health and Human Services and has long called for putting new requirements on Medicaid patients, including charging them more for their care.

Many patient advocates note that only a fraction of the people covered by Medicaid are of working age, nondisabled and currently unemployed. The main impact of the rules will be to subject poor people to paperwork that will drive some to drop coverage, the critics say.

A large majority of Medicaid recipients nationwide — almost two-thirds — are children, elderly or disabled. They will be exempt from the new requirements.

The administration is expected to approve requests from 10 states: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

Verma and other conservatives argue that forcing working-age Medicaid beneficiaries to work or seek work will improve their health.


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“States ... want more flexibility to engage their working-age, able-bodied citizens on Medicaid,” Verma told a gathering of state Medicaid directors in November. “They want to develop programs that will help them break the chains of poverty and live up to their fullest potential. We support this.”

According to a recent analysis by the nonprofit Kaiser Family Foundation, 6 in 10 of the nearly 25 million working-age, nondisabled adults on Medicaid already work full time or part time.

Of the remaining 10 million unemployed Medicaid enrollees, more than a third had an illness that prevented them from working, about another third were taking care of a family member, 15 percent were in school, 9 percent were retired and 6 percent said they couldn’t find work.

Michaela Ramm of The Gazette contributed to this report.



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