Governor Matt Bevin of Kentucky, a Republican, announced in a news conference on Friday that Kentucky Medicaid recipients will have to either work or be in a jobs training program to continue receiving benefits.
“Our policy guidance was in response to states that asked us for the flexibility they need to improve their programs and to help people in achieving greater well-being and self-sufficiency,” Verma said, noting the agency has received demonstration project proposals from 10 states: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.
The test programs, according to CMS, could make work, “skills training, education, job search, volunteering or caregiving” a requirement for Medicaid for “able-bodied, working-age adults.” It would not apply to those getting benefits due to a “disability, elderly beneficiaries, children, and pregnant women.”
Kentucky’s new work requirements mandate that able-bodied adult recipients participate in at least 80 hours of “employment activities,” (jobs training, education and community service) each month.
“Kentucky’s waiver, submitted for federal approval in 2016, requires able-bodied adult recipients to participate in at least 80 hours a month of “employment activities,” including jobs training, education and community service,” Reuters reported:
The rules apply to those between 19 and 64 years old. Certain groups are exempt, including former foster-care youth, pregnant women, primary caregivers of a dependent, full-time students, the disabled and the medically frail. The Trump administration also said states would have to make “reasonable modifications” for those battling opioid addiction and other substance-use disorders.
The federal Medicaid program began more than fifty years ago as part of President Lyndon Johnson’s War on Poverty. It originally provided financial entitlements to a small portion of the population, but in the half century since its creation the program has grown into a massive federal entitlement:
Created in 1965 along with Medicare, Medicaid was originally conceived as a program to provide health care to strictly defined groups: poor children deprived of parental support, their caretaker relatives, the elderly, the blind, and those with disabilities. In 1986, states were given the option to include poor, pregnant women and their infant children.
For a federal entitlement, it was remarkably limited and targeted to discreet populations. The idea was that Medicaid would only be for people who otherwise couldn’t get private health insurance or reasonably afford medical care. In other words, Medicaid didn’t originally cover almost any able-bodied adults. That’s not who it was for.
Kentucky’s new work requirements are already drawing criticism from liberal groups.
“Democrats and health advocacy groups blasted the federal policy on Thursday, saying it would make it tougher for the most vulnerable Americans to have access to healthcare. The Southern Poverty Law Center liberal advocacy group said it planned to file a legal challenge,” Reuters reported.
But Governor Bevin has pushed back firmly against these critics.
“One thing I want to clarify is that this requirement is for those that Medicaid was not originally designed for,” he told NPR, adding:
Why is it important to me? I’m a person who grew up with no access to this type of health care. I grew up well below the poverty level, never had the access to the health care system until I was an active duty Army officer in my 20s. So it’s a very personal thing. And I recognize that people in those positions don’t need, as Administrator Verma said, to be treated with the soft bigotry of low expectations. She’s exactly right…Go through any community anywhere, I promise you will see at least one sign where people want an able-bodied person who is not on drugs and will show up on time to apply for and do a job. There are plenty of jobs in America. There are 100,000-plus available in Kentucky right now. And this will start to connect people who want a job and need a job with the jobs that exist.
Other conservatives praised Bevin and President Trump.
“The Trump administration should be highly commended for this action,” Tim Huelskamp, Ph.D. a former congressman and the President of The Heartland Institute, said this in a statement, adding:
“Millions of Americans receive health insurance from their employer, meaning they work for it. There’s no reason why those who receive health insurance from taxpayers via Medicaid shouldn’t work for it, too. Kentucky’s requirement that able-bodied adult Medicaid recipients work at least 80 hours a month – either by pursuing more education and job training, or even volunteer in the community – is a very low but important hurdle. The Heartland Institute will continue to work with other states and the Trump administration to submit and approve waivers from other states.”
Matthew Glans, a Senior Policy Analyst at The Heartland Institute, added these details:
“The tipping point for Medicaid reform in the states is finally here. The approval of Kentucky’s well-crafted Medicaid waiver is the green light states across the country have been waiting for. The waiver’s approval signals that the Centers for Medicare and Medicaid Services and the Trump administration are truly open to the kind of systemic reforms that states need to transform their Medicaid programs and return them to the affordable safety nets they were intended to be.
“Work requirements are only one part of Kentucky’s waiver. It also provides for cost-sharing, giving Medicaid recipients more responsibility for their care and encouraging them to make better decisions with how they seek care. With Kentucky’s waiver as a model, states across the country should propose waivers of their own expanding on what Kentucky has done. This is only the beginning.”
Rep. Diane Black (R-TN-06), currently leading the field of five candidates for the Republican nomination for governor of Tennessee, according to a recent Tennessee Star Poll, is among the Republican politicians who have praised President Trump’s decision to allow states to require work by Medicaid recipients.
“As Chairman of the Budget Committee, I have pushed for work requirements for able-bodied, adult Medicaid recipients,” Black said in a statement released last week.
“I’m thrilled President Trump agrees and has announced he will give states the flexibility to create work-based health care programs that fit the needs of our individual states. I’m confident that we in Nashville know more about what the people of Tennessee need than bureaucrats in Washington,” Black added.
Tennessee is not among the ten states who have requested permission from the Trump administration to initiate a demonstration project to require work by Medicaid recipients.