The Trump administration has been signaling for months that it plans to implement conservative reforms to core federal welfare programs, including by allowing states to have work requirements for Medicaid. So it was no surprise on Thursday when the Centers for Medicare and Medicaid Services issued guidance for “state efforts to test incentives that make participation in work or other community engagement a requirement for continued Medicaid eligibility.”
In a series of tweets announcing the policy shift, CMS Administrator Seema Verma explained the agency’s rationale that requiring eligible able-bodied adults to have jobs to qualify for Medicaid will make them healthier and less reliant on welfare in the future. “Our fundamental goal is to make a lasting and positive difference in the health and wellness of Medicaid beneficiaries,” she tweeted. She also cited a 2014 meta-analysis that concluded that “employment is beneficial for health, particularly for depression and general mental health.”
Alabama has initiated the process to impose the work requirement:
Alabama may become one of nearly a dozen mostly Republican states that are seeking a waiver from the federal government that could allow the state to institute work requirements for some of those who are on Medicaid.
Gov. Kay Ivey said Tuesday that she has directed Medicaid Commissioner Stefanie Azar to begin working on seeking a waiver for the requirements and raising co-pays for beneficiaries. States are typically required to request waivers from the federal government for changes to their Medicaid programs.
“That process has been ongoing, and I look forward to the future implementation of those policies,” Ivey said.
So what does this mean for the elderly? In general in Alabama, the elderly would be exempt from the work requirement—as would children under 19 and pregnant women. Thus, an 85 year old widow with dementia will not have to get a job in order to keep her nursing home benefits.
However, the new rules may impact their caregivers. The devil will be in the details of Alabama’s proposal for the waiver. 30% of non-working Medicaid adults reported that they did not work because they were taking care of home or family.
Forbes details the scenario which may catch caregivers:
The administration guidance says that Medicaid recipients are exempt from the work requirement if they are caring for a “dependent.” But that may not mean what you think.
For some purposes, Medicaid uses the same definition of dependent as the Internal Revenue Service. According to the tax law, the rules for child dependents are pretty straightforward. Children qualify if they are under age 19, students under age 24, or if they are “permanently or totally disabled.” They must also live with their caregiver for at least half the year.
It is different—and more complicated– for older adults. They are subject to a seven-part test to qualify as a non-child dependent. For example, only certain relatives–such as parents, spouses, or siblings–are eligible. They can’t have more than about $4,000 in annual income and half their total support must come from the person who claims them as a dependent. In effect, that means that many people receiving Social Security benefits, Supplemental Security Income (SSI) or who are themselves on Medicaid may not meet the definition of a dependent.
The result: Even though that daughter may be spending 40 hours a week caring for her parents, they may not count as dependents. And that means she may lose her Medicaid benefits—and thus access to health care– unless she gets a paying job or meets other requirements.
Watch for the petition for waiver to know the details.