WASHINGTON — In a major policy shift that could affect millions of low-income people, the Trump administration said Thursday it is offering a path for states that want to seek work requirements on Medicaid recipients.
Seema Verma, head of the Centers for Medicare and Medicaid Services, said work and community involvement can make a positive difference in people’s lives and in their health. Still, the plan probably will face strong political opposition and even legal challenges over concerns people would lose coverage.
Medicaid is a federal-state collaboration covering more than 70 million people, or about 1 in 5 Americans, and that makes it the largest government health insurance program. It was expanded under President Barack Obama, with an option that has allowed states to cover millions more low-income adults; many have jobs that don’t provide health insurance.
People are not legally required to hold a job to be on Medicaid, but states traditionally can seek federal waivers to test new ideas for the program.
The administration’s latest action spells out safeguards that states should consider to obtain federal approval for waivers imposing work requirements on “able-bodied” adults. Technically, those waivers would be “demonstration projects.” In practical terms, they would represent new requirements for beneficiaries in those states.
The administration said 10 states — mostly conservative ones — have applied for waivers involving work requirements or community involvement. They are: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. Advocates for low-income people say they expect Kentucky’s waiver to be approved shortly.
“Medicaid needs to be more flexible so that states can best address the needs of this population,” Verma said in a statement. “Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries.” For close to a year, the administration has signaled an interest in helping states that want to institute work requirements.
Advocates for low-income people said work has never been a requirement for Medicaid, a program originally intended as a health program for the poor and disabled. It now covers a broad cross-section of people, from many newborns to elderly nursing home residents, and increasingly working adults.
“It is a very major change in Medicaid that for the first time would allow people to be cut off for not…