While the White House in recent weeks has taken steps to overturn a Trump-era initiative enabling states to restrict Medicaid eligibility by imposing punitive work requirements, healthcare advocates on Monday urged President Joe Biden to rescind all Medicaid work requirement policies approved by his predecessor.
In 2018, Seema Verma, then-director of the Centers for Medicare and Medicaid Services under former President Donald Trump, issued guidance allowing states to apply for a waiver to significantly alter eligibility requirements for Medicaid, a Great Society-era program on which more than 72 million low-income adults, people with disabilities, and children rely for health insurance.
Several Republican-led states quickly jumped at the offer to strip healthcare away from poor and vulnerable Americans, and the Trump administration ultimately approved policies to “take Medicaid coverage away from people who don’t comply with stringent work requirements” in 13 states, as Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities (CBPP), noted Monday in a blog post.
While litigation and the coronavirus pandemic have put the implementation of work requirement policies “on hold,” Wagner stressed that “taking coverage away from enrollees or otherwise conditioning coverage on meeting a work requirement doesn’t further Medicaid’s purposes,” which exists to provide healthcare to the impoverished. “Accordingly,” she added, “the Biden administration should now withdraw all of the previous approvals.”
The Trump admin approved policies in 13 state demo projects that take #Medicaid coverage away from people who don’t comply with stringent work requirements.
The Biden admin should now withdraw all of the previous approvals.https://t.co/rIHI3ndkPr
— Center on Budget (@CenterOnBudget) April 5, 2021
The White House in February invalidated the previous administration’s guidance allowing states to apply for Medicaid eligibility restriction waivers and notified states that had already been given permission to impose work requirements that the policies would soon be reversed due to the detrimental impact of coverage loss on Medicaid recipients, particularly during the pandemic, as Common Dreams reported at the time.
Last month, the Biden administration told Medicaid officials in New Hampshire and Arkansas — which was the first and only state to fully implement Medicaid work requirements, taking healthcare away from at least 18,000 people over a period of several months in 2018 — that approval for their work requirement policies had been rescinded.
While “Georgia, Indiana, Nebraska, Ohio, South Carolina, and Utah have objected” to Biden’s efforts to dismantle Medicaid work requirements, Wagner reiterated that “the administration should nevertheless continue with its plan.”
Wagner continued: “The Trump administration claimed that requiring work or other activities as a condition of coverage would ‘improve beneficiaries’ health,’ ignoring evidence from other programs suggesting these restrictions would significantly harm Medicaid enrollees. After states began implementing these policies, their experiences confirmed the harmful effects of work requirements.”
Citing a new analysis from the Department of Health and Human Services, Wagner wrote that “these policies are deeply harmful to Medicaid enrollees and confirms that they don’t promote Medicaid’s objectives.”
Referring to the 18,000 Arkansas residents who lost Medicaid coverage in 2018, Wagner said that “uninsurance rates among people subject to the work requirement rose, but their employment rates didn’t.”
Arkansans “who lost coverage were more likely to have chronic conditions, and many had difficulty paying their medical bills and accessing healthcare and medications,” she continued. “Data from New Hampshire and Michigan also show a significant loss of coverage would have occurred if the states’ work requirement policies had been implemented, largely due to enrollees’ limited awareness of the policies and challenges in reporting compliance.”
“The evidence of the detrimental impact of work requirements from Arkansas, New Hampshire, and Michigan demonstrates that other state policies would face the same challenges and harmful consequences,” she added. “All policies that take away coverage from people not meeting work requirements are marred by complex rules about who is exempt and what activities count, challenges communicating with enrollees, and burdensome paperwork and reporting requirements. These policies inevitably lead to eligible enrollees losing coverage — work requirements can’t be fixed.”
According to Wagner, “There’s nothing left to demonstrate by letting more states take risks with Medicaid enrollees’ health. The Centers for Medicare and Medicaid Services should withdraw all waiver authority for policies that take coverage away from people not meeting work requirements or otherwise condition coverage or benefits on meeting them and make clear that these policies won’t be allowed in Medicaid.”
Truthout Is Preparing to Meet Trump’s Agenda With Resistance at Every Turn
Dear Truthout Community,
If you feel rage, despondency, confusion and deep fear today, you are not alone. We’re feeling it too. We are heartsick. Facing down Trump’s fascist agenda, we are desperately worried about the most vulnerable people among us, including our loved ones and everyone in the Truthout community, and our minds are racing a million miles a minute to try to map out all that needs to be done.
We must give ourselves space to grieve and feel our fear, feel our rage, and keep in the forefront of our mind the stark truth that millions of real human lives are on the line. And simultaneously, we’ve got to get to work, take stock of our resources, and prepare to throw ourselves full force into the movement.
Journalism is a linchpin of that movement. Even as we are reeling, we’re summoning up all the energy we can to face down what’s coming, because we know that one of the sharpest weapons against fascism is publishing the truth.
There are many terrifying planks to the Trump agenda, and we plan to devote ourselves to reporting thoroughly on each one and, crucially, covering the movements resisting them. We also recognize that Trump is a dire threat to journalism itself, and that we must take this seriously from the outset.
Last week, the four of us sat down to have some hard but necessary conversations about Truthout under a Trump presidency. How would we defend our publication from an avalanche of far right lawsuits that seek to bankrupt us? How would we keep our reporters safe if they need to cover outbreaks of political violence, or if they are targeted by authorities? How will we urgently produce the practical analysis, tools and movement coverage that you need right now — breaking through our normal routines to meet a terrifying moment in ways that best serve you?
It will be a tough, scary four years to produce social justice-driven journalism. We need to deliver news, strategy, liberatory ideas, tools and movement-sparking solutions with a force that we never have had to before. And at the same time, we desperately need to protect our ability to do so.
We know this is such a painful moment and donations may understandably be the last thing on your mind. But we must ask for your support, which is needed in a new and urgent way.
We promise we will kick into an even higher gear to give you truthful news that cuts against the disinformation and vitriol and hate and violence. We promise to publish analyses that will serve the needs of the movements we all rely on to survive the next four years, and even build for the future. We promise to be responsive, to recognize you as members of our community with a vital stake and voice in this work.
Please dig deep if you can, but a donation of any amount will be a truly meaningful and tangible action in this cataclysmic historical moment.
We’re with you. Let’s do all we can to move forward together.
With love, rage, and solidarity,
Maya, Negin, Saima, and Ziggy