Medicaid Work Rules Unfolds

Medicaid 'Work Rules' Begins to Unfold in the U.S

Updated on Apr 01 2019


The Trump administration is beginning to roll out new work rules for Medicaid beneficiaries, compelling them to work or prepare for jobs to receive Medicaid benefits. This is the first time in the program’s history that working would be a requirement for benefits. Learn more about this policy and how it will affect seniors and other Medicaid beneficiaries.

Incentivizing Work for Medicaid Beneficiaries

A letter sent to State Medicaid Directors in January of 2018 announced a new Medicaid policy “designed to assist states in their efforts to improve Medicaid enrollee health and well-being through incentivizing work and community engagement among non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability.”

The new policy requires that Medicaid beneficiaries work, try to work or complete community engagement while making allowances for caregivers, the elderly and disabled persons. The legal issue concerning this change is that states must receive federal permission to depart from the usual Medicaid rules and the current law includes no work element. The Trump administration argues in the letter that, “”[A] growing body of evidence suggests that targeting certain health determinants, including productive work and community engagement, may improve health outcomes. While high-quality health care is important for an individual’s health and well-being, there are many other determinants of health.”

Critics are quick to refute the link between working and health and say the policy is solely about taking health insurance away from the poor. Eliot Fishman, senior health policy director at Families USA issued a statement calling the policy “unconscionable and illegal” adding, “Today’s announcement isn’t about work. It is about taking away health insurance from low-income people.”

Challenges as States Roll Out New Policy

Arkansas became the first state in the country to impose work requirements on the portion of Medicaid that was expanded under the Affordable Care Act. Seven other states will begin soon, and seven more will start soon after. The Trump administration and Republican governors hope that this change will encourage poor people to become more economically self-reliant. However, in Arkansas, which initiated the changes ten months ago in a program called Arkansas Works, 18,000 people have lost their insurance.

Additionally, two federal judges have issued opinions that the changes to Medicaid “cannot stand.” The twin opinions tell federal health officials they must reconsider the changes and think about how poor people who rely on Medicaid will receive insurance if working is mandated. “I am a big fan of work and people working,” said Rep. Reginald Murdock, a veteran state legislator from Marianna. But, he argues that with jobs in his area so scarce, “threatening people with their insurance wasn’t a proper way to do it.”

Healthcare Changes on the Horizon

As the current administration attempts to make its mark on healthcare, they are calling for the Affordable Health Care Act to be struck down in its entirety. If they are successful in removing the entire law, the health care of every American, regardless of age, would be impacted. This is especially concerning with the aging baby boomer population and the cost of healthcare in retirement. Under the Affordable Health Care Act, Americans receive free annual checkups, mammograms, cholesterol tests, flu shots and birth control. Even the current administration is using the law to lower the cost of prescription drugs.

Additionally, the law prohibits insurance companies from charging more or denying policies based on medical histories. More than 25 percent of Americans have a condition that could have left them uninsurable before the Affordable Care Act too effect. The law requires insurers to cover all applicants and also to provide comprehensive benefits.

A report from the Urban Institute found that if the law is struck down, nearly 20 million additional people would be left without medical insurance and hospitals could see uncompensated care jump 82 percent to $50 billion.

These changes to healthcare in America have the potential to have a profound effect on seniors and their caregivers. If you are unsure or are concerned about paying for healthcare, contact a fiduciary financial advisor who can help you create a holistic financial plan for your future.

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