On Thursday, January 11th, Seema Verma, the Administrator of the Centers for Medicare and Medicaid Services (CMS), took to her official Twitter account to make an announcement that has the potential to reshape Medicaid coverage eligibility across the country. Citing multiple studies that highlight the positive effects of work on an individual’s health and wellbeing, Administrator Verma announced a new set of detailed policy guidelines that are intended to assist states as they design and implement Section 1115 Medicaid waiver demonstrations that include community engagement requirements, also known as work requirements. While the current leadership of CMS has previously expressed that they are open to supporting such waivers, these policy guidelines provide a very clear path for interested states to have a demonstration approved.
What Do The Guidelines Look Like?
According to the new guidelines, CMS will support individual state’s attempts to create work or community engagement eligibility requirements for Medicaid that align with their existing program requirements for other community support programs such as Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP). Other guidelines include a recommendation that demonstrations include a wide variety of activities that are approved to meet the community engagement requirements. These options may include, but are not limited to, paid work, job training, community service, job searching, and caregiving. As part of their ongoing commitment to fight the opioid epidemic, CMS has also recommended that substance abuse programs count towards community engagement requirements.
Under the new policy guidelines, community engagement requirements are only intended to affect able-bodied, working age adults. Exemptions will be granted for groups that have traditionally been served by Medicaid, such as pregnant women, medically frail adults, children, and the elderly. Exemptions may also be recommended for able bodied adults in areas with high unemployment rates or other severe economic situations. Any approved state programs will also be required to maintain full compliance with all federal disability and civil rights employment laws.
Kentucky Leads The Way
One day after introducing the new policy guidelines, CMS announced that Kentucky would be granted the necessary waivers to implement their sweeping Medicaid reform program, branded Kentucky HEALTH. Originally designed and submitted in 2016, Kentucky HEALTH is intended to address a wide variety of concerns in the commonwealth. In order to combat the serious health and economic concerns facing their enrollees, as well as control costs, Kentucky HEALTH includes such reforms as income based premiums, incentives for participating in preventative care and wellness programs, access to education and training opportunities, and community engagement requirements that mirror the state’s existing SNAP and TANF work registration criteria.
Demonstrations are Tests
Though there are many conflicting opinions on the value and drawbacks of implementing work requirements for Medicaid eligibility, it is important to note that these new guidelines do not make work requirements mandatory; they simply make them available for states that believe they will be beneficial. Nor do these policies make any approved demonstrations permanent. By definition, Section 1115 waivers do not change the legal framework for the Medicaid program, they only create short-term test cases to demonstrate the validity of state-specific policy approaches. In the case of community engagement requirements, as in the case of all waivers, CMS will be continually assessing the long-term viability of these programs by observing the positive and negative effects that these demonstrations have on both the wellbeing of individuals and the cost effectiveness of the Medicaid program.