Trump’s Medicaid Work Requirement Will Backfire

A doctor meeting with a patient at a clinic in Whitesburg, Ky., which is in a region with a high proportion of people enrolled in Medicaid. The Trump administration said Thursday that it would allow states to impose work requirements for Medicaid recipients.

Just because President Trump and the Republican Congress were unable to pass health care legislation that would have unwound the coverage benefits of the Affordable Care Act doesn’t mean such attacks are behind us. To the contrary, Republicans are now making an end run around Congress to accomplish one of their harshest goals: kicking economically vulnerable people off Medicaid.

The administration’s new approach — one that no administration before it has taken — is to provide waivers to states that allow them to impose work requirements for Medicaid benefits. Thus far, the Centers for Medicare and Medicaid Services has received requests for such waivers from 10 states. C.M.S. released guidance on Thursday describing how states can institute these work requirements.

Even before Thursday, C.M.S. had unilaterally changed the standards a waiver must meet to accord with Medicaid’s core mission — specifically, that whatever they do, states must increase and strengthen health coverage for people of limited means. Now the administration will be considering waivers that are likely to deprive thousands of low-income people of health care.

Some of these people will lose coverage because they can’t find jobs to fulfill the work requirements. Others will lose it because they fail to complete paperwork proving they’re working or that they qualify for exemptions. For example, people with mental illness, addiction or chronic disease often struggle to meet bureaucratic demands; in programs that already demand that beneficiaries work, such individuals have often been punished for falling short on work requirements even though they’re supposed to qualify for exemptions.

Instead of requiring states to increase and strengthen coverage, C.M.S. will now allow them to use waivers to promote “upward…

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