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CMS Issues Guidance Permitting States to Introduce Medicaid Work Requirements

January 11, 2018

Early today, Centers for Medicare & Medicaid Services (CMS) issued policy guidance to state Medicaid agencies describing how states can impose work requirements as a condition of Medicaid eligibility for able-bodied, working age adults. 
In order to implement these policies, states must submit and receive federal approval for what is known as a “Section 1115 Waiver.” The new policy document provides the criteria and parameters for states to submit a successful waiver request. Among other things, the guidance identifies:

  • Who must be excluded from the requirements (children, people with a disability, elderly individuals, pregnant women, and people with opioid addiction)
  • What qualifies as “work” (it can include community engagement activities such as job training and volunteering) 

CMS explained that ten states have applied for federal waivers to add work requirements, and that this guidance was issued in response to this state interest. The Obama Administration turned down several state requests to add work requirements.
Because children, elderly individuals, and people with disabilities constitute the majority of Medicaid eligible—and a large percentage of Medicaid consumers already work full-time—the policy would have a relatively limited impact.  However, policy analysts assert that the policy will have a chilling effect on Medicaid enrollment. 
As recently as last year, the Pennsylvania General Assembly passed legislation directing the Department of Human Services to seek a waiver from CMS to permit Medicaid work requirements.  The Governor, however, vetoed this legislation.   
Moving forward, HAP will continue to work with the Governor and the General Assembly to maintain access to health care for Medicaid enrollees. 
For more information, please contact Scott Bishop, HAP’s senior vice present, legislative advocacy, Laura Stevens Kent, HAP’s vice president, federal advocacy, or Jeff Bechtel, HAP’s senior vice president, health economics and policy. 

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