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Medicaid Work Requirements: Coming Soon to a State Near You

Last Friday, the Trump Administration approved a plan for Kentucky to overhaul how Medicaid is distributed in the state by adding work requirements to eligibility standards. The change is the first of its kind, as Medicaid eligibility has been determined solely by income level or disability status since the program’s creation in 1965. Healthcare advocates worry that introducing work requirements will limit people’s access to coverage by adding yet another bureaucratic hoop to jump through – especially as it has been seen time and again that the majority of Medicaid recipients who can work already do.

Work requirements are often touted to be a marker of the conservative ideal of increasing personal independence (as espoused in the 2016 RNC platform), but in reality are often just another barrier to keep people living in poverty, people of color, and people with chronic health conditions from accessing affordable healthcare. The new Kentucky plan, which is in line with the guidelines released last week from the Centers for Medicare & Medicaid Services (CMS), will likely exclude those who are disabled/differently abled, pregnant, elderly, and living with substance use disorders from the requirement to work, undermining even further the conservative rhetoric that the Medicaid system is being abused by people who don’t really need it. Healthcare scholars have also noted the potential for racial discrimination in the rule.

As George Washington University professor Sara Rosenbaum explains, there could be exceptions to the work requirement for people living in areas where there are fewer work opportunities – like rural areas, which are also most often predominantly white. If a state decides to give exemptions such as these, it leaves people living in poverty in urban areas, which are more likely to be inhabited by people of color, as the only ones burdened by the extra requirements, increasing the possibility that they could lose health coverage due to inability to work or bureaucratic error.

The Trump Administration’s move to approve Medicaid work requirements shows an ignorance of – or a blatant disregard for – the needs of Americans living in poverty, people of color, and especially people with chronic health conditions that may make employment impossible. Kentucky Governor Matt Bevin has already said that he will take drastic actions – such as cutting Medicaid coverage for nearly 400,000 Kentuckians – should the court system bar the work requirements plan, and it is likely that the Administration would support him and other Republican governors seeking to institute similar plans. Medicaid covers the healthcare costs of more than 40% of people living with HIV.

AIDS United will work with partner organizations as well as Congress to oppose any changes to Medicaid that would cause people, especially people living with long-term health needs, to lose the health coverage they require and deserve.  


Posted By: AIDS United, Policy Department - Friday, January 19, 2018

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