Work Requirements Might Ultimately Increase Medicaid Enrollment

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Jack Crowe Political Reporter
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The Trump administration’s decision to allow states to implement work requirements for Medicaid enrollment may actually increase enrollment nationally as the newly permitted work requirements provide latitude for Republican lawmakers in conservative states to consider Medicaid expansion.

At least six states are now considering expanding Medicaid to allow more low income adults access to the program, which was originally intended for vulnerable populations like children, the disabled and the elderly. Republicans in Utah, Wyoming, Idaho, North Carolina, Virginia and Kansas are reexamining the possibility of expanding Medicaid — something 32 states and the District of Columbia have already done — because the Trump administration has begun issuing waivers to allow states to require able-bodied adult enrollees to be employed, in school, looking for a job or doing community service.

The Obama administration sought to expand Medicaid eligibility to all Americans living under 133 percent of the federal poverty line but was prevented from mandating the expansion by a federal court, which preserved the states’ authority to deny expansion.

Seventeen mostly Republican controlled states have resisted Medicaid expansion efforts due to the political cost of appearing soft on “able-bodied” adults relying on the government, not to mention the fiscal impact of expansion on the state budget. The granting of work requirement waivers, which was effectively banned under the Obama administration, allows states the flexibility to expand Medicaid absent much of the political and financial cost previously associated with such a move.

“All of a sudden, we’re seeing some flexibility that allows us to do it our way, and that gives it a much better chance,” Wyoming state Sen. Ogden Driskill, a Republican who previously opposed Medicaid expansion told The Washington Post. “Without the heavy hand of the government forcing it down our throats, many of us will take a much deeper look at it.”

“I’m not Captain Ahab; I didn’t see the point in pursuing an expansion bill that wasn’t going to get approved,” Utah state Rep. Robert M. Spendlove told WaPo. “The importance of the Trump administration’s willingness to give states flexibility to manage their programs can’t be overstated.”

Ten states have filed for a waiver allowing the implementation of work requirements since the administration announced states could begin applying in early January. Kentucky is the only state that has been granted a waiver thus far, while the others remain under review.

The potential for work requirements to spur Medicaid expansion in states previously hostile to the idea has not been sufficient in convincing liberal critics of work requirements, many of whom still believe they represent a threat to low middle income Americans.

“Expanding does create the opportunity to cover more people, but if it’s done with things like work requirements, premiums and other similar policies we know reduce coverage, the gains won’t be as large,” said MaryBeth Musumeci, a Medicaid expert at the Kaiser Foundation.

Medicaid experts warn the work requirements must be carefully implemented to avoid the unintended consequence of vulnerable populations being denied coverage.

“With this guidance from CMS, it will be essential for states and stakeholders in the states – including insurance providers – to understand the details of who will be impacted by work requirements, how these requirements will be defined and administered, and how people who are impacted will be directed to new pathways for coverage and care,” Senior Vice President for Communications at AHIP, Kristine Grow, told The Daily Caller News Foundation.

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