Repeal of Medicaid Work Necessities Attracts Reward and Complaints

WASHINGTON – The Biden government’s decision to lift Medicaid’s work requirements waiver in four states has mixed assessments by the healthcare community.

Work demands “can definitely be a barrier to access, and we absolutely must avoid that,” said Ada Stewart, MD, president of the American Academy of Family Physicians, in a telephone interview. “You could end up harming patients who need Medicaid most.”

Nina Schaefer, Senior Research Fellow for Health Policy at the Heritage Foundation, a right-wing think tank here, disagreed with this. “The whole purpose of a waiver is for states to experiment with different approaches to how they want to manage the Medicaid program,” she said in a telephone interview. “Other social programs have done a lot with job demands, so why not Medicaid? … The idea of ​​welfare is not to live a life of permanent welfare, but as a ladder to get out of the welfare hole and get a higher income achieve – these types of things should be rewarded and not viewed as negative. “

Last week, CMS officials informed Medicaid directors in Arizona and Indiana that they are withdrawing approval for Medicaid’s work requirements in those states. The government took similar action in March in New Hampshire and Arkansas, despite both states appealing the lawsuit to the Supreme Court under Bloomberg’s law.

The time offs granted by the Trump administration under the 1115 Leave Program generally require Medicaid applicants to demonstrate they participate in “community engagement” activities, employment (at least 80 hours per month), professional training, school can include enrollment or volunteer work. The policies also contain exceptions – for example, Arkansas exempts students, the disabled, those responsible for full-time care of a child or other family member, and pregnant women.

In her June 24 letter to Arizona Medicaid Director Jami Snyder, CMS Administrator Chiquita Brooks-LaSure stated that under federal law and regulations, “CMS may withdraw exemptions or spending authorities if[s] The [a] Demonstration project is unlikely to achieve the legal purposes.

After realizing the impact of the pandemic on the Medicaid program – including the increased unemployment and lack of economic opportunity, as well as the long-term effects of COVID infection that require ongoing medical care – she continued, “At least given the significant risks outlined above and uncertainties regarding the adverse effects of the pandemic and its consequences, the information available to CMS does not provide a sufficient basis for a positive assessment that the commitment to community engagement is likely to help achieve Medicaid’s goals. “

“Accordingly, CMS hereby withdraws the approval of the portion of the January 18, 2019 amendment that allows the state to include work and community involvement as a condition of eligibility under the [Medicaid] Demonstration.”

The CMS letter to Indiana Medicaid director Allison Taylor contained similar views. “We have no evidence before us to suggest that the state has taken steps that are likely to reduce the risks of the Indiana demonstration project, resulting in significant insurance losses, while loss of access to health care would cause significant harm to beneficiaries.” Brooks-LaSure wrote.

“CMS has determined that authorities conditionally allowing Indiana to require community engagement as a condition of continued eligibility are unlikely to promote the goals of the Medicaid Charter as a whole. Therefore, we are withdrawing the community engagement authorities, which were approved conditionally on October 26, 2020, renewal approval of the HIP [Healthy Indiana Plan] Demonstration.”

According to Schäfer, this withdrawal of permission after the already approved waiver opens a real Pandora’s box. “A precedent is that the government would now reopen a treaty agreed between the federal government and the state to provide the exemptions,” she said. “Is this one way waivers will move in future governments, where new governments are now reopening the Biden government waivers and saying,” OK, we disagree with these guidelines and are going to stop them again? That will have a really chilling effect on innovation at the country level. “

But Gary Rosenfield disagreed. “It might open a Pandora’s box, but if it’s bad policy, the Pandora’s box needs to be opened,” said Rosenfield, senior vice president at ConsejoSano, a health technology company that focuses on culturally-oriented liaison with members of the Specializes in Medicaid Plans. “It’s aimed at people who don’t necessarily have a voice, and it’s taking the wrong approach… The whole idea of ​​someone sitting around and saying, ‘I want to be on Medicaid so I won’t work’ is in my opinion a ridiculous thing. Statistics show that people who are not old, blind or disabled – the vast majority of them are working. “

“As long as the Biden administration makes it clear why they are reversing the policy and why it was bad policy to begin with, and selling and explaining why they do it … would make it defensible,” Rosenfield said during a phone interview at a PR person was present.

Thomas Johnson, executive director of the Population Health Alliance, a trade organization for groups interested in population health management, said in an email that while his organization did not take a position on work requirements, “I haven’t seen any evidence from any state “. As a result, all of the goals of proponents of such requirements have been met. ”In addition,“ I think there have been a number of challenges for those enrolled across the country. In Arkansas, the state relied solely on an on-line system for enrollees to enter the required information, and that state has the largest Internet access gap in the world country. “

• Joyce Frieden oversees MedPage Today’s Washington coverage, including stories from Congress, the White House, the Supreme Court, health care associations, and federal agencies. She has 35 years of experience in health policy. consequences