Capitol Correspondence - 02.11.19

CMS Not Enforcing Reporting Rules Surrounding Medicaid Work Requirements

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ANCOR is sharing this article by the Los Angeles Times because in the past we have shared concerns with the Centers for Medicare and Medicaid Services (CMS) about work requirements having potential harmful consequences for people with I/DD and for the Direct Support Professional workforce who assists them. ANCOR continues to monitor the discussion around this topic.

As shared by the LA Times:

“As it races to revamp Medicaid by allowing work requirements for the first time, the Trump administration is failing to enforce federal rules directing states to assess the impact of the change on low-income patients who rely on the half-century-old safety net program, a Times analysis shows.

None of the eight states that the administration has cleared to implement a Medicaid work requirement has in place a plan to track whether Medicaid enrollees find jobs or improve their health, two goals often touted by administration health officials.

And nine of the 17 states that have sought federal permission to implement Medicaid work mandates have been allowed by the Trump administration to proceed with their applications despite failing to calculate the number of people who could lose coverage, according to a review of state and federal Medicaid records.

Federal regulations issued under the Obama administration direct states seeking permission to experiment with new Medicaid policies to, in most cases, estimate effects on coverage before the initiative starts, and then independently evaluate the impact of the programs after they begin to assure they are achieving their goals.

Nevertheless, Arkansas, which the Trump administration celebrated in June as the first state to implement a Medicaid work requirement, still has no approved research plan, even though the state has already removed more than 18,000 people from Medicaid coverage for failing to comply with its mandate.


Alabama, for example, acknowledges in its application that approximately 16,000 people will likely lose standard Medicaid coverage as a result of its mandate, state filings indicate.

However, state officials seeking permission to implement work mandates in Arizona, Arkansas, Kansas, Michigan, New Hampshire, Oklahoma, South Dakota, Tennessee and Wisconsin did not project in any detail how their experiments would affect Medicaid enrollees’ coverage, according to a review of hundreds of pages of state documents filed with the federal Center for Medicare and Medicaid Services, or CMS.


The lack-of-coverage projections come despite 2012 federal regulations specifying that requests to implement Medicaid experiments ‘will not be considered complete’ unless states include ‘an estimate of the expected increase or decrease in annual enrollment.’

Nevertheless, the Trump administration deemed all the state Medicaid applications ‘complete,’ CMS documents show.”