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What happened?  

In a major shift that could affect millions of low-income people receiving benefits, The Trump Administration announced Thursday, January 11, that it will open the door for states to require work requirements for Medicaid recipients.  

The guidance was published in a letter from CMS Deputy Administrator Brian Neale to State Medicaid Directors Thursday morning. In the letter, Deputy Administrator Neale stated that the move would help “improve Medicaid enrollee health and well-being through incentivizing work and community engagement.” 

Ten states – Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin – have already sent in proposals to add work requirements for Medicaid, according to CMS. The states need federal approval to begin the requirements. 

CMS Administrator Seema Verma voiced her support for the guidance on Twitter, stating “Activities that increase education and training help #Medicaid beneficiaries find sustainable employment, leverage hope, and achieve a better quality of life” 

Critics of the move believe that this is a dramatic shift in policy. “Conditioning Medicaid eligibility and coverage on work is a fundamental change to the 50 plus year history of the Medicaid program,” said MaryBeth Musumeci, Associate Director of the Kaiser Family Foundation’s Program on Medicaid and the Uninsured.  

According to a recent study by Kaiser Family Foundation, 40% of Medicaid adults don’t currently work. Among them, 36% are ill or disabled, 30% are caregivers, 15% are students and 9% are retired.   

Softheon’s VP of Government Solutions, Michael Sasko added, “The new guidance from CMS highlights the need for Managed Care Organizations (MCOs) to be adaptive and agile, as the regulatory environment can change quickly.”    

What happens next? 

The new guidance and approvals of waivers for work requirements are likely to spur lawsuits from Democrats and consumer advocacy groups who argue that imposing job requirements would illegally block access to coverage. 

Critics say the Trump administration is misusing its authority to grant waivers, using a process intended to allow states to experiment with Medicaid’s structure to rewrite it instead. 

Republicans say work requirements would help beneficiaries move from Medicaid into employer-based coverage. Some states seeking the requirements say they would also reduce enrollment. 

Ten states are currently applying to impose work requirements in Medicaid. Many experts expect Kentucky will be the first state approved1. 

How can Softheon help? 

Softheon’s vast experience in healthcare IT and agile-approach to implementation can be used to help MCOs and state Medicaid agencies adapt and excel in this ever-evolving regulatory landscape. Our team is currently working in the state of Kentucky to help with the implementation of a new Medicaid expansion program.  




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