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Washington - Under Trump, States May Demand Work For Medicaid

Published on: April 20, 2017 12:26 PM
By: AP
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FILE - The federal government forms for applying for health coverage are seen in Jackson, Mississippi October 4, 2013.  REUTERSFILE - The federal government forms for applying for health coverage are seen in Jackson, Mississippi October 4, 2013.  REUTERS

Washington - Work requirements for Medicaid could lead to major changes in the social safety net under President Donald Trump.

It sounds like a simple question: Should adults who are able to work be required to do so to get taxpayer provided health insurance?

The federal-state Medicaid program for low-income and disabled people covers more than 70 million U.S. residents — about 1 in 5 — including an increasing number of working-age adults. In a break from past federal policy, the Health and Human Services department under Secretary Tom Price has already notified governors it stands ready to approve state waivers for “meritorious” programs that encourage work.

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Separately, an amendment to the still-stuck House GOP health care bill would allow individual states to require work or training for adults, with such exceptions such as pregnant women, or parents of a disabled child.

Yet a surprising number of working-age adults with Medicaid are already employed. Nearly 60 percent work either full- or part-time, mainly for employers that don’t offer health insurance, says the nonpartisan Kaiser Family Foundation. Most who are not working report reasons such as illness, caring for a family member, or going to school.

Geraldine Stewart, a Medicaid beneficiary from Charlotte, N.C., questioned the impact of a work requirement on older adults. Stewart was incapacitated by painful problems with her feet, now relieved by surgery covered under the program. In her early 60s, she was able to return to part-time work as a home health aide after treatment.

“To do work anywhere, I have to have my feet,” said Stewart. “I really hope that they do not force anyone who has a medical condition to work to have to pay for those services. I don’t think it’s been researched properly.”

The debate over work requirements for safety net programs isn’t new. With Medicaid, it doesn’t break neatly along liberal-conservative lines.

On the political right, some say the idea is flawed because a person who refuses to work will still be able to get free treatment by going to a hospital emergency room. Others say Medicaid was established by law as a health program, and work requirements would compromise that original mission.

“It’s a policy that comes out of a misunderstanding of the situation facing low-income families,” Jason Helgerson, head of New York’s Medicaid program, said of work requirements. “People need health care to function in the work force. Threatening that, in my view, does not help in any meaningful way.”

In a recent letter to governors, HHS Secretary Price and Seema Verma, the new head of Medicare and Medicaid, suggested that work itself can be good for health. “The best way to improve the long-term health of low-income Americans is to empower them with skills and employment,” they wrote.

Liberals are relishing the contrast if Trump pursues tax cuts for the wealthy while putting the poor to work. “The Republican focus is backwards,” said Senate Democratic Leader Chuck Schumer of New York.

Work requirements are under discussion in a number of states, and the first test for the Trump administration could come on a pending waiver application by Kentucky. The proposal from Republican Gov. Matt Bevin would allow the state to suspend coverage for able-bodied adults who don’t comply. Job training and caring for a disabled relative would count toward fulfilling the obligation. “Medically frail” people dealing with certain conditions, from substance abuse to cancer, would be exempt.

For Bevin, getting federal approval is key to continuing a Medicaid expansion launched by his Democratic predecessor to take advantage of then-President Barack Obama’s health care law. Nationwide, the future of the expansion is uncertain with Republicans committed to rolling back Obama’s law. Work requirements could entice GOP-led states to expand their programs and cover more low-income adults.

That may be more symbolism than real change, said Robert Rector, a social policy expert with the conservative Heritage Foundation.

“I consider it misleading to suggest you are going have a meaningful work requirement in a medical program, because that’s the most difficult area to do it in,” said Rector. “If an individual doesn’t perform, and then they get sick, it’s just not going to be enforced.”

Advocacy groups representing the poor may go to court. “Medicaid is a medical assistance program,” said Jane Perkins, legal director the National Health Law Program. “We do have a problem” with making work a condition of eligibility.

Others are worried that work requirements could become barriers for people down on their luck.

In small-town Paris, Tenn., Medicaid beneficiary Mayela Stephenson said, “I wasn’t afraid of work.”

Now in her mid 50s, she worked factory jobs most of her life before becoming disabled due to nerve and bone problems. Even with her disability, Stephenson said she had to get legal help to force the state to grant her Medicaid.

Although she agrees that able-bodied people should work, Stephenson said she has concerns that those with health problems will get hurt.

“How would one measure someone’s disability as to what degree that person would be able to work?” she asked. “It would have to be based on each individual’s circumstance. You would have to go case-by-case, and how on earth will they do that?”



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Read Comments (17)  —  Post Yours »

1

 Apr 20, 2017 at 12:33 PM Anonymous Says:

Great Idea. I hope that everyone who voted for Trump will move to States where Trump won instead of staying in Sanctuary States like NY. NJ. California etc. There is a great need of Kollelim in Nebraska, Louisiana, No Dakota etc.

2

 Apr 20, 2017 at 12:34 PM Anonymous Says:

Yes everybody should go to work. We will have much less kids getting of the Derech and it will end the Siduch crisis.

3

 Apr 20, 2017 at 01:17 PM Educated Archy Says:

Not enough .

They should limit medicad to x amount of years . During that time you should be encouraged to find higher paying jobs and better family planning .

The point is we need to figure out a way to wean people off programs . Currently , the altitude is why work hard . If I make under 50k I get tons of programs but if I go over and earn 60k I loose it all . Thus I gotto be crazy to work so hard . I'll find an easy job where I work yet still make under the limit . We need to start caring about the above 50 k earners getting squeezed .

4

 Apr 20, 2017 at 02:33 PM triumphinwhitehouse Says:

half the people on disability are fine as well, so I support this very much as everything that Trump does.

5

 Apr 20, 2017 at 02:35 PM Anonymous Says:

Are all you people nuts here?? What will happen to all the beautiful mishpuchas with the k"h 5 to 10 kids each??? Nebach, all these yingelaat and kollel people will suffer and won't be able to sit and support their growing families, k"h.

6

 Apr 20, 2017 at 04:06 PM Educated Archy Says:

Reply to #5  
Anonymous Says:

Are all you people nuts here?? What will happen to all the beautiful mishpuchas with the k"h 5 to 10 kids each??? Nebach, all these yingelaat and kollel people will suffer and won't be able to sit and support their growing families, k"h.

Not sure if you are kidding or not . I think you are . But here is the problem . Our beautiful 10 child family will continue getting medicad . Because usually one parent does work just earns a low income thus between work and rabbinical college you satisfy the work requirement .

This is why I say , it does not go far enough . We must address the issue of people purposely earning under the poverty line so that they maximize programs including earned income tax credits . They have no incentive to work harder

7

 Apr 20, 2017 at 07:37 PM Anonymous Says:

Reply to #5  
Anonymous Says:

Are all you people nuts here?? What will happen to all the beautiful mishpuchas with the k"h 5 to 10 kids each??? Nebach, all these yingelaat and kollel people will suffer and won't be able to sit and support their growing families, k"h.

"Yingelaat and kolel people" most of them voted for Trump. Maybe they wanted out of the current situation. Now they can get a job like everybody.

8

 Apr 20, 2017 at 09:24 PM yamsar Says:

Reply to #3  
Educated Archy Says:

Not enough .

They should limit medicad to x amount of years . During that time you should be encouraged to find higher paying jobs and better family planning .

The point is we need to figure out a way to wean people off programs . Currently , the altitude is why work hard . If I make under 50k I get tons of programs but if I go over and earn 60k I loose it all . Thus I gotto be crazy to work so hard . I'll find an easy job where I work yet still make under the limit . We need to start caring about the above 50 k earners getting squeezed .

We must eliminate it completely. The program is immoral. It is collected forcefully in the form of taxation from the working class. In plain words it's called theft. Governments can't just confiscate private property for whatever program they wish to provide.

9

 Apr 20, 2017 at 11:35 PM Anonymous Says:

If this goes trough, quite a few groceries will go out of business in Boro Park not to mention the banks.

10

 Apr 20, 2017 at 11:37 PM Anonymous Says:

Reply to #6  
Educated Archy Says:

Not sure if you are kidding or not . I think you are . But here is the problem . Our beautiful 10 child family will continue getting medicad . Because usually one parent does work just earns a low income thus between work and rabbinical college you satisfy the work requirement .

This is why I say , it does not go far enough . We must address the issue of people purposely earning under the poverty line so that they maximize programs including earned income tax credits . They have no incentive to work harder

What happened to your previous handle, TrumpISprez?? Finally realized that the orange mess just might get us into WW3??

11

 Apr 21, 2017 at 12:01 AM Trump yungerman Says:

Reply to #7  
Anonymous Says:

"Yingelaat and kolel people" most of them voted for Trump. Maybe they wanted out of the current situation. Now they can get a job like everybody.

Have no fear .

1) I am sure college students are exempt from the work requirement
2) As long as one parent works it usually suffices .

This won't affect us . To the contrary it will just leave us with more goodies as others are eliminated

And don't forget that zaidy kushner s name is on the wall in bmg!

12

 Apr 21, 2017 at 09:07 AM perfumed_bed Says:

Good. The money thus saved can be put to a much better use. Like making a few holes in concrete at some third rate Syrian airbase.

13

 Apr 21, 2017 at 09:22 AM Anonymous Says:

Reply to #12  
perfumed_bed Says:

Good. The money thus saved can be put to a much better use. Like making a few holes in concrete at some third rate Syrian airbase.

More like making more holes on fat and skinny dictators like Putin, Assad and Kim Jung-un.

14

 Apr 21, 2017 at 09:36 AM perfumed_bed Says:

1) I am sure college students are exempt from the work requirement

Yes, COLLEGE students, I'm sure. Not 40 year old permanent KOLLEL benchwarmers.

2) Foodstamps are next and so are other govt programs. If you think this will not affect the frumme because zeidy kushner's name on the bgm wall, or because Ivanka visits the ohel or some such thing, you are just deluded.

15

 Apr 21, 2017 at 10:26 AM Educated Archy Says:

Reply to #10  
Anonymous Says:

What happened to your previous handle, TrumpISprez?? Finally realized that the orange mess just might get us into WW3??

No not all .

Trump will not at all get in trouble . Some imposter claims its his name . So I switched . Besides I get bored of the same name after a while .

If you'd like I can change it to something like TrumpISherefor8yrs. But it's too long so I have to rethink

16

 Apr 21, 2017 at 10:35 AM Trump yungerman Says:

Reply to #14  
perfumed_bed Says:

1) I am sure college students are exempt from the work requirement

Yes, COLLEGE students, I'm sure. Not 40 year old permanent KOLLEL benchwarmers.

2) Foodstamps are next and so are other govt programs. If you think this will not affect the frumme because zeidy kushner's name on the bgm wall, or because Ivanka visits the ohel or some such thing, you are just deluded.

According to the government a 40 yr old in a rabbinical college is still a college student . You may view things differently but you are not the government . This does already work in many areas.

So again kolel guys have nothing to fear . Let them expand it to food stamps too .

17

 Apr 21, 2017 at 10:39 AM Educated Archy Says:

Reply to #12  
perfumed_bed Says:

Good. The money thus saved can be put to a much better use. Like making a few holes in concrete at some third rate Syrian airbase.

Or you mean like blowing up close to 100 ISIL fighters via the Moab bomb .

And that Syrian air base was not third class . And it made a huge statement which was more than Obama did when innocent civilians were gased

18

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