In its guidance issued Thursday, CMS said it would support state requests to require adult Medicaid beneficiaries to work or engage in skills training, education, job search, caregiving or volunteer service.
States would need to do so through a specific waiver with CMS.
Under the proposed work requirement, people will have to prove that they're working or performing some other qualifying activity such as volunteering. "We're just making it harder for them".
Republican candidate Scott Wagner, a York County state senator and businessman, supports the work requirement guidelines outlined, said his campaign spokesman Andrew Romeo.
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. In the 1980s and '90s many states expanded eligibility to pregnant women, regardless of income or marital status.
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".
A September poll from Politico and the Harvard T.H. Chan School of Public Health had nearly identical overall numbers, with 72 percent of Americans in favor of "requiring low-income, able-bodied adults without young children to work in order to receive Medicaid benefits". ME has a total of 268,000 Medicaid recipients, including children and people who are not physically able to work.
It now covers a broad cross-section of people, from many newborns to elderly nursing home residents, and increasingly working adults.
"Productive work and community engagement may improve health outcomes", said Brian Neale, the director of the federal Medicaid office.
The application clarifies some language about who would be exempt from the work requirements and the lifetime limits. But a closer look reveals that many of those people face obstacles to entering the workforce.
Together, these data indicate that hundreds of thousands of able-bodied Nevadans receive Medicaid coverage without having to work.
"The state has little evidence for why the current Gateway to Work program would fare better if mandatory", wrote Jon Laramore, executive director of Indiana Legal Services.
States seeking waivers must ensure that beneficiaries who live in areas with high unemployment are able to meet work requirements, or at least link them to resource for job training, though they can not use federal Medicaid funds for this goal. After President Bill Clinton signed welfare reform into law in 1996, the share of families below the poverty line that receive welfare benefits dropped from 68 percent in 1996 to 23 percent in 2016, according to CBPP.
Still, the work requirement is a bit befuddling.
States would have to build new systems to determine who is subject to work requirements and verify whether beneficiaries fulfilled them, said LaDonna Pavetti, vice president at the Center on Budget and Policy Priorities, a left-leaning think tank.
Thursday's administration guidance to states spells out safeguards that states should consider in seeking work requirements.
Republicans have been pushing for the change since the Affordable Care Act added millions of able-bodied adults to Medicaid. Those who don't could lose their insurance for six months at a time.
KFF reports that almost 9 in 10 (88 percent) of non-SSI Medicaid adults who report not working have a functional limitation and more than two thirds (67 percent) have two or more chronic conditions, such as asthma or arthritis.
The new Centers for Medicare & Medicaid Services guidance, which allows states to seek federal permission to establish restrictions, could threaten the Medicaid coverage of the many adults with disabilities, children and the elderly who cannot work.
Ironically, the first waiver request the Trump administration is likely to approve is from Kentucky, a state that has benefited enormously from Medicaid coverage for people facing opioid addiction. An increase in the access requirements, no matter what those requirements entail, will necessarily reduce the number of people who are able to access Medicaid.
Most of the population that would qualify for Medicaid expansion already works, Venable said.