Medicaid Work Requirement Guidelines Issued

Yesterday, CMS announced "new policy guidance for states to test community engagement for able-bodied adults," otherwise known in common vernancular as work requirements. CMS is framing this announcement as a way to support state efforts to improve Medicaid recipient health outcomes by incentivizing work for "able-bodied, working-age Medicaid beneficiaries." The policy is in response to 10 states that have requested a "115 Medicaid Waiver" demonstration program under which work or "participation in other community engagement activities"- which include things like skills training, education, job search, volunteering or caregiving - qualify as a condition for Medicaid eligibility. Excluded from the program are the disabled, elderly, children, and pregnant women, who make up the majority of Medicaid recipients. The 10-page letter issued yesterday, argues that working promotes good health and repeatedly asserts that the change fits within the program's objectives. 

Critics argue that able bodied individuals who are collecting Medicaid and are not sick or caring for family members - or students, are a relatively small portion of the overall Medicaid population, which now covers one in every five Americans and is the nation's largest insurance program. Also, many Medicaid recipients already work full time, but have wages so low that they still qualify for Medicaid. Recent analysis by the Kaiser Family Foundation, and JAMA put the true number of able bodied, non elderly, unemployed (i.e. not a caregiver, student, or volunteer), and not retired, at somewhere between 13%-25% of the Medicaid ranks, and most of those are older workers (51-64). They also argue that the cost of implementing and administering such a program may not result in much cost saving.

In Maryland, of the more than 1.2 million Medicaid recipients in the state, 390,000 are classified as non disabled, or non elderly. 74% of them are working or have a family member already working. 

Of the 10 states that have applied for the waiver program, Kentucky may be the first state to enact the new requirements - perhaps as early as today.