ADEA State Update

Trump Administration Announces New Policy for Work Requirements Under Medicaid

(Medicare and Medicaid, Federal Policy) Permanent link   All Posts

SeemaVermaJanuaryOn Jan. 11, the Centers for Medicare & Medicaid Services (CMS) announced a new policy to assist states in efforts to improve Medicaid enrollee health and well-being through incentivizing work and community engagement among non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability.

“Medicaid needs to be more flexible so that states can best address the needs of this population. Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today’s announcement is a step in that direction,” said Seema Verma, CMS Administrator. 

Specifically, the guidance document, issued to State Medicaid Directors, describes considerations for states that may be interested in pursuing demonstration projects under section 1115(a) of the Social Security Act that have the goal of creating incentives for Medicaid beneficiaries to participate in work and community engagement activities.

To date, CMS has received demonstration project proposals from 10 states that include employment and community engagement initiatives: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

The true impact of this new policy shift by CMS is unknown; however, in April 2017, Health Affairs estimated the number and characteristics of adults likely to be subject to a work requirement using data from the 2015 National Health Interview Survey.[1] Nationwide, about 22 million adults covered by Medicaid (58% of all adults on Medicaid) could be subject to a work requirement. Fifty percent of the 22 million are already working, 14% (3 million) are looking for work and 36% (8 million) are neither working nor looking for work.

ADEA will keep you updated as more information is gathered and analyzed.


[1] Health Affairs used the 2015 National Health Interview Survey to identify Medicaid recipients ages 18 to 64 who might be subject to a work requirement. They considered those receiving Supplemental Security Income (SSI) or Social Security Disability Insurance because of a disability to be exempt due to that disability; those receiving aid from the Special Supplemental Nutrition Program for Women, Infants, and Children to be exempt as caretakers of children younger than age six; and those who are pregnant to be exempt due to that pregnancy. Work status is based on employment in the past week.

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