Work demonstration requirement center for medicare and medicaid

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States are allowed to experiment with their Medicaid plans using pilot programs or demonstration waivers. One example of a Medicaid waiver involves work rules, which require able-bodied adults to work a minimum number of hours each month or participate in an equivalent activity as a condition for continued Medicaid eligibility. Equivalent activities include skills training, education, job searching, volunteering or caregiving. First, most Medicaid recipients already work. Second, a majority of recipients work full-time in low-wage industries with low rates of employer-sponsored insurance.

Third, of those who do not work, a majority would be exempt anyway. Lastly, persons who remain eligible could lose coverage by failing to meet reporting requirements. The Obama administration previously rejected all such proposals.

CMS issued guidance on how states should design their waiver proposals to increase the likelihood of approval. Under the guidance, certain recipients must be exempt from work requirements, such as those with disabilities, the elderly, children and pregnant women. Of those nine, the programs of three states -- Arkansas, Kentucky and New Hampshire -- have been temporarily halted by challenges in federal court. Another nine states currently have waiver applications pending.

Similarly, research finds that work requirements in TANF —the program that replaced AFDC—have had little impact on increasing employment over the long-term, as most TANF enrollees are either already working or face significant employment barriers that work requirements do not address. Finally, a review of research on the relationship between work and health found that although there is strong evidence of an association between unemployment and poorer health outcomes, there is limited evidence on the effect of employment on health.

As most Medicaid enrollees are already working or face barriers to work, work and reporting requirements may cause coverage loss among eligible enrollees without increasing employment. A analysis suggests that if all states were to implement Medicaid work requirements, between 1. Research suggests work requirements could have particular adverse effects on certain Medicaid populations, such as women , people with HIV , and adults with disabilities including those age 50 to Available implementation data suggests that Medicaid work and reporting requirements were confusing to enrollees and result in substantial coverage loss, including among eligible individuals.

Lack of computer literacy and internet access among enrollees created barriers to setting up online accounts as well as ongoing reporting. Research indicates that enrollees in Arkansas were unaware of or confused by the new work and reporting requirements, which did not provide an additional incentive to work beyond economic pressures. The Biden Administration began the process to withdraw Section work requirements in February and has since issued final withdrawals for all states that had approvals.

CMS generally reserves the right to withdraw approved waiver authorities at any time it determines that these authorities are no longer in the public interest or promote Medicaid objectives. CMS subsequently withdrew Medicaid work requirement waivers in all states that had approvals. The letters also highlighted that job and income loss among the low-income population during the COVID pandemic were likely to exacerbate the risks of coverage loss under work requirements.

No states were implementing work requirements at the time of withdrawal, either due to the pandemic, litigation see Appendix Table 2 , or prior termination by the states themselves see Figure 1. Before leaving office, the Trump Administration asked the Supreme Court to reverse these appeals court decisions and the Court agreed to hear the cases in December In April , the Biden Administration asked the Court to vacate the lower court decisions and dismiss the Arkansas case as moot as that waiver had expired and remand send the New Hampshire case back to HHS as New Hampshire had not asked the Court to review the case involving its waiver.

In April , the Court granted this motion, effectively putting an end to the pending litigation. For more information on work requirement litigation across states, see Appendix Table 2 and Figure 1. Each case challenging work requirements see Appendix Table 2 has centered on the administrative record of the underlying waiver approvals under the Trump Administration, with courts finding that these approvals were unlawful because they were unsupported by the administrative records.

Specifically, the courts found that the Secretary did not consider impacts on coverage contained in the administrative records. Although the Biden Administration has concluded that it does not believe work requirements further Medicaid program objectives, CMS under future presidential administrations could issue new guidance encouraging work requirement waivers and approve such waivers based on a different interpretation of program objectives—though these would likely face legal challenges.

For example, although Arkansas removed its work requirement in its new waiver , the state noted that should federal law or regulations permit the use of a work requirement as a condition of eligibility in the future, it would seek to amend the demonstration accordingly. In a departure from previous administrations, the Trump Administration encouraged and approved Section waivers that conditioned Medicaid coverage on meeting work and reporting requirements.

Based in part on this data, the Biden Administration withdrew all approved work requirement waivers by the end of ; Georgia has since challenged the withdrawal of its work requirements in court.

This issue brief answers key questions about these provisions: What is the history of Medicaid and work requirements? What do we know about the impacts of Medicaid work requirements? What is the current status and future of Medicaid work requirements?

Requirement medicaid center medicare work demonstration for and kaiser permanente los angeles medical center los angeles ca

Work demonstration requirement center for medicare and medicaid	Logan Mortenson is a compliance attorney editor for Thomson Reuters. Second, a majority of recipients work full-time in low-wage industries with low rates of employer-sponsored insurance. In Aprilthe Biden Administration asked the Court to vacate the lower court decisions and dismiss the Arkansas case as moot as that waiver had expired and remand send the New Hampshire case back to HHS as New Hampshire had not asked the Court mediciad review the case involving its waiver. Research shows that being in poor health is associated with increased risk of job loss, while access to affordable health insurance has a positive effect on the ability to obtain and maintain employment. The Biden Administration had concluded that these provisions reduce coverage and thus do not promote the objectives of the Medicaid program. GAO found that three of the five states received CMS approval for federal funds—in one case, tens of millions of dollars—for administrative costs that did not appear dekonstration or at higher matching rates than appeared appropriate per This web page guidance.
Work demonstration requirement center for medicare and medicaid	Prospects for overturning the District Court decision in the appeals court appear slim. Source: Requifement analysis of data reported by selected states and selected state documents. Prior to the Trump Administration, no states had received waiver approvals to condition Medicaid coverage on work and reporting requirements, and legislative attempts click at this page incorporate work requirements into Medicaid statute failed. States are allowed to experiment with their Medicaid plans using pilot programs or demonstration waivers. The Obama administration previously rejected all such proposals. However, these rules have recently met significant legal opposition erquirement multiple states. Another nine states currently have waiver applications pending.
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Activities include caregiving, drug treatment, education, employment and volunteerism. Not everyone will be faced with a Medicaid work requirement. Each state that applies for a waiver specifies who is exempt from the requirement. For each exemption category, a state may require that different criteria be met. The most common exemption is age.

All states excuse anyone 65 years and older from these work requirements. Some states allow more flexibility. Arizona, Arkansas, Ohio and Wisconsin exempt people 50 years and older; Montana 55 years and older; and six states 60 years and over. Caring for children 6 years and younger or for a dependent disabled child or adult generally makes one exempt as well. Some states may extend this to older children and even foster care. Although hours spent in drug treatment meets the work requirement in some states, it is considered an exemption in others.

Students are also excluded from the requirement. However, the age of the student and the number of hours of school attendance may come into play. Being on unemployment compensation could make you exempt in some states.

Those who support Medicaid work requirements argue it will save money for the states. However, it may also lead to more spending. In , when the Medicaid waivers were first approved, only 33 states, including the District of Columbia, had pursued Medicaid expansion.

By , 39 states had expanded Medicaid. A number of law suits fought against Medicare work requirements, claiming they changed the intended purpose of Medicaid which is to provide health care for the poor. Federal district courts blocked the requirements from taking effect in Arkansas, New Hampshire, Kentucky, and Missouri. Indiana subsequently withdrew its work requirements due to the political climate.

Under the Biden administration, the Centers for Medicare and Medicaid Services has sent letters to the eight states previously approved for work requirements as well as the four states where the courts had temporarily halted them. Medicaid could undergo some major changes. Starting in , states applied to add work requirements to their Medicaid programs. To date, four programs have been waived by the courts. Others have been approved but not implemented. Ten are pending. While some people may be exempt from these work requirements based on age, caregiving, disability, or for being an active student, many won't.

Whether or not you are for or against Medicaid work requirements, more states may choose to expand Medicaid as a result.

Centers for Medicare and Medicaid Services. Opportunities to promote work and community engagement among Medicaid beneficiaries. A "cap" on Medicaid: how block grants, per capita caps, and capped allotments might fundamentally change the safety net. PB Health-related outcomes among the poor: Medicaid expansion vs. PLoS One. Sohn H, Timmermans S. Social effects of health care reform: Medicaid expansion under the Affordable Care Act and changes in volunteering. Social Security Administration.

Cardwell A. A snapshot of state proposals to implement medicaid work requirements nationwide. National Academy for State Health Policy. Kaiser Family Foundation.

Medicaid Waiver Tracker: approved and pending Section waivers by state. Health Insurance. By Tanya Feke, MD.

Tanya Feke, MD. Learn about our editorial process. Fact checked Verywell Health content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. Get Involved Create a Memorial Fundraiser. Get Involved Awareness Events. Get Involved Share Your Story. Get Involved Partner with Us. Advocacy Advocate for Change. Advocacy Policy Priorities. Advocacy Policy Platform.

Advocacy Crisis Intervention. Advocacy State Fact Sheets. Advocacy Public Policy Reports. Medicaid: Work Requirements. Know the warning signs Learn the common signs of mental illness in adults and adolescents.

Mental health conditions Learn more about common mental health conditions that affect millions. Why We Care Access to coverage and care is essential for people to successfully manage their mental health condition and get on a path of recovery.

How We Talk About It Across the country, millions of people with mental illness rely on Medicaid, including many who live with severe conditions. Only one in five adults with mental health conditions who receive community mental health services are competitively employed — and the numbers drop to only one in ten for people with schizophrenia.

Studies of work requirements have shown they do not lead to long-term, stable employment. Instead, work requirements merely increase state administrative costs and complexity. Additionally, there are people with mental illness who have not been determined disabled, but may not be ready to work, including: Young adults experiencing their first symptoms of serious mental illness People whose mental health symptoms are so severe they cannot navigate the disability system People who have discharged from psychiatric hospitalization but need ongoing treatment While states may exempt some vulnerable people from work requirements, most states do not have effective systems to do so.

As a result, people with mental illness may fall through the cracks and lose their coverage. These comments are available by request.