On 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
“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.
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.
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.