A Medicaid Work Requirement Would Be Bad Policy Without The Opioid Crisis. It’s Disastrous With It.

The Trump administration opened the doors Thursday for states to set work requirements for people who get Medicaid, a move that is likely to be a catastrophe for some of the most vulnerable Americans, particularly those struggling with opioid addiction.

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. 

And, since the expansion of Medicaid under the Affordable Care Act, its benefits have been a key component in addressing the rise of substance abuse. From 2011 to 2016, Medicaid spending on prescription treatments for opioid use disorder rose from $394.2 million to $929.9 million, according to a report from the Urban Institute, a left-leaning Washington, D.C., think tank.

The guidance letter does acknowledge the severity of the opioid crisis. It says states must “take certain steps” to provide coverage for people in need of substance abuse treatment, potentially by counting time a person spends in treatment toward work requirements or by exempting those participating in “intensive medical treatment.”

But Sara Rosenbaum, a law professor at the Milken Institute School of Public Health at George Washington University, said the letter doesn’t actually bar states from kicking people with substance abuse problems off their insurance.

“There’s absolutely nothing that requires the exemption of people with addiction,” Rosenbaum said. “They just said there are considerations…. It does not say you can’t do anything that would impair access to treatment.”

Even if people in treatment, or with other circumstances that prevent them from working, are legally entitled to an exemption under state rules, another big issue is how many hoops they’ll have to jump through to keep getting medical care. Under state work requirements, people have to verify their work status or their qualification for an exemption, according to MaryBeth Musumeci, associate director of Kaiser Family Foundation’s Program on Medicaid & the Uninsured. In some cases, they may have to file paperwork as often as every month to verify that they’re still exempt.

“There is a real risk of eligible people losing coverage due to their inability to navigate this process or miscommunication or other breakdown in the administrative process,” she said in an email to HuffPost.

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