Capitol Correspondence - 08.20.18

Administration Pushing More Medicaid Changes, Including Workforce Requirements

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According to Politico Pro:

“The Trump administration is poised to let conservative-led states impose more controversial changes to pare their Medicaid rolls, including work requirements in three states and a limited drug testing qualification sought by Wisconsin Gov. Scott Walker, according to four individuals with knowledge of the process.

An attempt by Arizona to impose work requirements but exempt Native Americans is expected to be denied as part of the review — a move that effectively reiterates the administration’s position that members of tribes might need to get jobs to keep their health care.

HHS and Justice Department officials are additionally finalizing the Medicaid work requirements sought by Maine, amid broader legal uncertainty about the state’s health program under Republican Gov. Paul LePage, who has refused to implement a voter-approved Medicaid expansion.


The goal is to make the latest Medicaid changes withstand simultaneous legal challenges, similar to those targeting early versions of President Donald Trump’s travel ban, according to officials familiar with the process.”

According to a report by the state of Arkansas, in that state alone 5,000 beneficiaries are expected to lose Medicaid benefits due to not reporting that they are working as part of compliance with the state’s Medicaid work requirements. According to a Georgetown University study, “in July a whopping 83 percent of people who were expected to log onto the website and report activity did not do so. This is even higher than last month, when 72 percent of people expected to take action did not. With two strikes against them, it’s clear that many beneficiaries appear to be unaware that they were even sent up to bat.” The report goes on to mention that poor internet access plays a role in the poor response rates.

On a larger scale, the Urban Institute has found that the Kentucky work requirements proposal could lead to roughly 55,000 individuals losing Medicaid benefits.  

Members interested in following how political races in states where Medicaid 1115 waivers or Medicaid expansion are shaping up might be interested in this analysis by Health Affairs.