President Donald Trump’s administration told states Friday they can wait until July before removing people from Medicaid for failing to meet a work requirement.
This requirement is set to go into effect nationwide on January 1, and states have been working to have the personnel, training and technology in place to implement it by then. The administration clarified that while states still have the option to take action early in the year, they will not have to exclude anyone or deny coverage for failure to meet the requirement before July 1.
Medicaid is the joint state and federal health insurance program for low-income people. The Centers for Medicare and Medicaid Services told state Medicaid directors Friday that they will still need to determine whether many enrollees and benefit applicants meet new requirements that they work, attend school or volunteer.
READ MORE: Judge Blocks Trump Administration’s Medicaid Work Requirement Rule That Mandates Proof of Medical Frailty
The decision announced Friday gives state social services more time to ensure complex changes are ready to be implemented before there are consequences. CMS said states are making progress but experiencing implementation challenges.
“I think those extra six months are going to give states the ability to respond to the change, and there will be fewer people who lose coverage due to administrative failures” resulting from states’ failure to prepare, Kathy Hempstead, senior policy manager at the Robert Wood Johnson Foundation, told the Associated Press.
Still, she said it was unclear which states would choose to use the additional time.
Kate McEvoy, executive director of the National Association of Medicaid Directors, said state Medicaid leaders “appreciate the additional flexibility provided by CMS.”
There is political pressure on this requirement
The ruling could also give Congress some breathing room to consider changes to that requirement. Democrats, who will take control of both chambers in January after their stunning election victories last week, have said they want to roll back those demands.
The news comes after Democratic Sen. Ron Wyden of Oregon and Rep. Frank Pallone Jr. of New Jersey wrote to CMS Administrator Dr. Mehmet Oz this week asking him to delay implementation of the work reporting requirements. Their letter cites, in part, a recent ruling by a Boston federal court that medically fragile people should not be bound by qualification rules required for the job.
“The practical reality is that this significant implementation issue may not be definitively resolved for months, creating untenable uncertainty for States that need a final resolution of this issue before implementing employment reporting requirements,” the letter said. “The court’s decision is an important victory for the millions of medically fragile people who rely on Medicaid for their health care coverage.”
READ MORE: As Work Requirements Tighten for Medicaid, Some States Take a Tougher Stance
Under this policy, many Medicaid recipients must work or volunteer at least 80 hours per month or be in school at least half time. The new policy applies only to people who receive Medicaid as part of a voluntary expansion undertaken by 40 states that aimed to provide health coverage to more low-income adults who don’t have children at home. There are exceptions for those who are over 64, caring for children under 14 or deemed too frail to work.
Critics say most enrollees covered by the mandate are already working and people are more likely to lose coverage because of the paperwork to prove it than not working.
The federal government is pushing states to use data from other government departments or elsewhere to verify whether beneficiaries are working, to reduce the burden on beneficiaries to present evidence.
Critics fear administrative part is biggest problem
A few states started work requirements early.
The first of these was Nebraska, where they started in May.
Preliminary data presented to the state’s Medicaid Advisory Committee showed that more than 9 in 10 people subject to work requirements and scheduled to have their benefits renewed in July and August were eligible.
But 533 people were denied continued coverage. For most of them, it was a matter of paperwork: they could not prove that they were working or that they were exempt from this obligation. Of the denied applications, 43 lost coverage because they did not meet the new requirements.
READ MORE: As States Face Stricter Medicaid Work Requirements, Nebraska Is A First Test
Similarly, most new Medicaid applicants who were denied coverage due to work requirements from May through August did not obtain coverage because they did not provide information to verify their compliance.
Among both groups, it’s unclear how many people didn’t provide information because they weren’t working — or how many could meet the requirements but failed to show it.
“There are probably people still eligible for coverage who have lost it,” said Amy Behnke, CEO of the Health Care Center Association of Nebraska.
A free press is the cornerstone of a healthy democracy.
Support trusted journalism and civil dialogue.
Gn headline
Customer challenge
