Trump's new Medicaid work requirements punish disabled people like me

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The move allows states to apply for waivers from the Centers for Medicare & Medicaid Services (CMS) that will give them the go-ahead to require Medicaid enrollees to work in order to receive health care coverage.

CMS will support state efforts to align Medicaid work and community engagement requirements with SNAP or TANF requirements, where appropriate, as part of this demonstration opportunity.

And yet, Seema Verma, administrator of the Centers for Medicare and Medicaid Services, is touting work requirements as a way to enable individuals covered by Medicaid to "break the chains of poverty" and "live up to their highest potential".

In fact, we don't have to look any farther than welfare reform to find evidence that a Medicaid work requirement won't help people find long-term employment or escape poverty. Local patient advocates said they hope IL does not join the 10 states that already have submitted proposals to make having a job a condition of Medicaid eligibility, for fear it would leave tens of thousands of people without health insurance.

Currently, 10 states have applications pending that ask for permission to include some type of work requirement: Arizona, Arkansas, Indiana, Kentucky, Maine, Kansas, North Carolina, New Hampshire, Utah, and Wisconsin.

Soon, the administration will likely approve "waiver" proposals, starting with Kentucky and IN and followed by other states, to end Medicaid coverage not only for people who aren't working, but also for those who didn't pay premiums - or renew their coverage - on time. It covers 75 million low-income children, adults, elderly and disabled Americans.

According to Politico, in 2014 Obamacare allowed states to offer healthcare coverage to low-income individuals who suffered no debilitating medical problems. "As Medicaid has expanded to able-bodied individuals, the needs of this population are even more imperative". Just 6 percent say they want to work but can't find a job. "And so the net effect of this policy isn't going to be to get more people to get jobs, it is for more people not to have health care, they are going to get sicker and have less ability to get jobs".

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Verma stressed that the administration is providing an option for states to require work, not making it mandatory.

The agency said it is encouraging states to consider a range of activities that could satisfy work and community engagement requirements. The guidance cites research that it says demonstrates people who work tend to have higher incomes associated with longer life spans, while those who are unemployed are more prone to depression, "poorer general health", and even death. In states that decide to impose the new requirement, it is widely expected to shrink Medicaid rolls. The federal memo instructed states to craft "reasonable modifications" allowing Medicaid enrollees who need addiction treatment to continue accessing services.

Ten states, all of which have Republican governors, recently applied for waivers to impose work requirements.

The National Health Law Program, a law firm that promotes access to health care, wrote in a letter to Neale that it "appears that CMS has decided on a policy position first and then cherry-picked a small number of studies". These jobs ebb and flow with the seasons and economy, so it also might be hard for them to comply with reporting requirements under new rules.

Has Pennsylvania considered a work requirement? CMS is blocking states from using any savings derived from cutting off people's Medicaid to achieve revenue neutrality.

"One of the things that states have told us time and time again is that they want more flexibility to engage their working-age, able-bodied citizens on Medicaid", Verma told a conference of state Medicaid directors in November. Opposing work requirements for able-bodied beneficiaries, she said, was "soft bigotry" on the part of the Obama administration, which hadn't approved a waiver Verma helped design in IN which originally contained such a provision.

"It's basically creating layers of government, confusion, bureaucracy that doesn't need to be there for people who are probably working anyway", she said. According to the study, the majority who were not working said they were ill, caring for a family member, or attending a school. The state's proposal would require Medicaid beneficiaries to work, job search, or care for someone with a disability for 20 hours per week.

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