/Trump Administration cools on Mississippi Medicaid work requirements

Trump Administration cools on Mississippi Medicaid work requirements

Last week, the Trump Administration pulled back support for waivers in Mississippi states that have opted out Medicaid expansion. This puts a question mark over an controversial program that has strong support from Gov. Phil Bryant. Phil Bryant. Verma, like many conservatives, has long supported Medicaid work requirements. She said they “promote engagement in the community.” However, Verma’s comments last week echo criticisms of the waiver program, who claim that work requirements could lead to more than 20,000 Mississippians being forced out of the Medicaid program. The Mississippi Division of Medicaid submitted its application in November. It is still awaiting approval by CMS. However, it does not contain a plan for addressing a subsidy cliff. “We are not opposed making adjustments to waiver applications to achieve this goal, and we are actively working on refining the application where possible.” Mississippi’s governor did not respond to inquiries for comment. Verma’s remarks last week were not the first time an official of the Trump Administration acknowledged that the work requirements could lead to some beneficiaries being uninsured. However, concerns about a subsidy-cliff in states that aren’t expanding the Medicaid program is not new to the health care community. Only four states have received waiver requests approval, and they are Kentucky, Arkansas, Indiana, New Hampshire and Indiana. All of these states have expanded Medicaid. The approval of Mississippi’s application is still pending. This is one of three non-expansion state applications. Anyone can apply for Medicaid in expansion states if their income is not sufficient to qualify them for a subsidy through the state insurance exchange. Mississippi is a non-expansion country, so Medicaid eligibility is not available to adults. One exception is the low-income parents and caretakers who make up seven percent of the state’s 700,000. These recipients would be subject to the work requirements. They will need to work 20 hours per week, or participate in job training. This is because the income limits for these beneficiaries are so low, as low as $306 per month, that even a minimum wage job could make them ineligible to Medicaid. Verma’s subsidy cliff is where a person earns too much to be eligible for Medicaid or too little to receive a tax credit. This category includes approximately 50,000 Mississippians. A Georgetown University Center for Children and Families report in April estimated that if Mississippi’s federal government approves the application as it stands, up to half of these people could lose their coverage within five years. They claim that the waiver will provide a foundation for good health and that work requirements make it possible to get coverage. Roy Mitchell, executive director for the Mississippi Health Advocacy Program, stated that it is impossible for this population to have both Medicaid and employment coverage. “If these programs were implemented as written, I predict that you’re going see legislators running to the exits.” CMS didn’t respond to a request for clarification on how the Division of Medicaid would have to modify its application. Medicaid currently offers transitional insurance that covers an individual for the first 12 month after they are out of the program. Mitchell stated that it is unlikely that someone will go from being unemployed to working in a job with health insurance benefits within a year. Mitchell stated that it would be difficult to implement the program in a state with very few health insurance jobs. The program’s most vocal supporters and critics considered Mississippi’s request for a waiver in its current form to be all but guaranteed. Bryant, in his January State of the State speech dismissed the controversy by arguing that work restrictions are not meant to be a “punitive measure” but to help “help this population reap the benefits of a job, and one-day receive health care coverage from the employer, not the state of the federal government.” Georgetown University published a detailed report last month on the impact of work requirements on Medicaid beneficiaries. Joan Alker, the executive director of the Center for Children and Families at Georgetown acknowledged that waivers for work requirements in states that don’t have Medicaid expansion were not guaranteed approval. She said that Mississippi’s application was closer than any other non-expansion state application. “Mississippi has gone through both the federal and state public comment process. Alker stated that Mississippi is ahead Alabama in the queue. Mississippi is the one to watch. The Trump Administration has not stated that it intends to waive Medicaid recipients from non-expansion countries, despite concerns about the potential consequences. Verma described the program as a response for Medicaid expansion in November. She said it was to “move millions of working-age, disabled adults into a program that was designed to care seniors in need, pregnant women, children, and people with disabilities.” The Trump Administration submitted a brief late last month to expand on this idea. Stewart v. Azar is a lawsuit filed by a group Kentucky Medicaid recipients against the federal government regarding their state’s recently adopted work requirement. The federal Department of Health and Human Services defended the waiver by describing the program as an “experimental project” that encourages “members of Medicaid expansion population to engage with healthy behaviors.” Jameson Taylor is vice president of Mississippi Center for Public Policy. A conservative think tank, Taylor has supported the implementation of a Medicaid work requirement for Mississippi. He acknowledged Wednesday that Trump Administration might be focusing their attention on states that have expanded their Medicaid programs. “But just because we are more comfortable with work requirements for expansion states than we are for non-expansion state doesn’t mean that we won’t have work requirements here. Taylor stated that it just means it might take longer.”