Under the rules, states can require Medicaid beneficiaries to work, volunteer or participate in job training. Advocates for low-income people say they expect Kentucky's waiver to be approved shortly. The decision may mean some changes for the Ohio's Medicaid program. The guidance also includes caregiving as one of the activities.
Still, critics fear a work requirement could have a chilling effect on people signing up for Medicaid or make it harder for people to get coverage. Most recipients will be able to choose whether to be covered by a prepaid plan or a provider-led entity.
But work requirements have strong public backing.
She cited studies that show a correlation between good health and having a job.
The agency's guidance provides states with a lot of flexibility in designing their programs and highlights that many recipients may need additional considerations.
-Exempting pregnant women, disabled people and the elderly. However, they will not be allowed to use federal Medicaid funding to finance these services. The guidance marked a major policy shift in the joint federal-state health program for low-income and disabled Americans.
President Donald Trump and his administration have consistently said they are seeking to overhaul Medicaid, which was greatly expanded under President Barack Obama as part of his landmark overhaul of America's health care system.
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The Health and Human Services Department outlined how states could reshape the program in a directive. "While high-quality health care is important for an individual's health and well-being, there are many other determinants of health".
Verma, and proponents of the requirements view it differently. Verma, sent a letter to governors hours after after she was confirmed in March urging them to apply for such waivers. "This is about helping those individuals rise out of poverty".
Ten states have applied for a federal waiver to add a work requirement - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.
"Access to Medicaid makes it easier for people to look for work and obtain employment", says Suzanne Wikle of the Center for Law and Social Policy.
Public Citizen agreed, calling the idea of work requirements "cruel, stupid and illegal".
"There are a lot of different ideas, and a lot of ways to go about this", she said.
The administration contends the policy is to promote "community engagement". "Those days are over". There was no indication that the open path toward work requirements makes Medicaid expansion any more palatable in a Republican-controlled General Assembly that has repeatedly rejected it, though.
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In fact, "a$3 mong the adult Medicaid enrollees who were not working, most report major impediments to their ability to work including illness or disability or care-giving responsibilities", according to the independent Kaiser Family Foundation. "The analysis noted that, 'More than one-third of those not working reported that illness or disability was the primary reason for not working. almost nine in ten (88%) non-SSI Medicaid adults who report not working due to illness or disability has a functional limitation, and more than two-thirds (67%) have two or more chronic conditions such as arthritis or asthma'".
KFF expressed concerns about 1115 demonstrations with work requirements because the majority of Medicaid members not working said they have a major disability, while working Medicaid members could face other administrative obstacles in receiving benefits.
Medicaid, unlike cash welfare payments, isn't a disincentive to work, because it doesn't provide people with funds they'd need to pay rent or buy food, said Jeff Grogger, an urban policy professor at the University of Chicago.
It now covers a broad cross-section of people, from many newborns to elderly nursing home residents, and increasingly working adults.
Consumer advocacy groups are likely to consider legal action once CMS starts approving state waivers.
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