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Feds encourage work requirement in Medicaid for able-bodied adults

State House Bureau

January 12. 2018 12:21AM

CONCORD — Federal officials are now encouraging states to consider work or community involvement requirements for able-bodied Medicaid recipients, a key part of the New Hampshire approach to the federally funded health insurance program for low-income households.

The state has in the past sought permission from the federal government to impose work requirements on certain Medicaid recipients, but under the Obama administration was denied.

New Hampshire is one of 33 states that opted to expand eligibility for Medicaid to embrace a larger portion of the population through the Affordable Care Act (Obamacare). Each vote to expand Medicaid in recent years has had a sunset date, and the current authorization expires at the end of 2018.

The legislature passed a law in 2017 stating that the program will not be renewed this time around, unless a work requirement is authorized.

The announcement by the federal Center for Medicare and Medicaid Services (CMS) on Thursday regarding work requirements improves the chances for continuation of Medicaid expansion in the Granite State, and sets the stage for what Gov. Chris Sununu has called a New Hampshire solution.

In a 10-page letter to state Medicaid directors, CMS Director Brian Neale announced the new federal approach, “designed to assist states in their efforts to improve Medicaid enrollee health and well-being through incentivizing work and community engagement.”

The letter stresses that a work requirement would be acceptable only for “non-elderly, non-pregnant adult beneficiaries who are eligible for Medicaid on a basis other than disability.”

Such able-bodied adults were not eligible for Medicaid in New Hampshire prior to the 2014 expansion, which has led to an additional 50,000 enrollees.

Waiver still needed

The state will still have to apply for a waiver and undergo the full federal review process, but CMS will now support state efforts to “test incentives that make participation in work or other community engagement a requirement for continued Medicaid edibility,” according to the Jan. 11 letter.

Sununu said the announcement is good news for the state’s pending waiver application.

“Work requirements offer opportunities to lift individuals out of poverty, empower them with the dignity of work and self-reliability while also allowing states to control the costs of their Medicaid programs,” he said in a statement released soon after the CMS announcement. “We are committed to helping more people get into the workforce, as it is critical not only for individuals but also for our economy as a whole.”

In an interview on Wednesday, Sununu talked about the need for a New Hampshire Medicaid plan.

“When we talk about the expanded Medicaid population, we’re going to design a New Hampshire plan to deal with that population,” he said. “We’re working now both internally with the legislature as well as with the federal government to see what flexibilities we can gain to design the best plan, a New Hampshire-based plan, for New Hampshire citizens.”

A bipartisan commission appointed to study the issue over the summer, led by Majority Leader Jeb Bradley, R-Wolfeboro, recommended that the program be continued but left many of the details to lawmakers — including how the state will pay for its 10 percent share of the expansion in 2020 and beyond.

“We’re exploring a lot of different opportunities for where those funds can come from,” Sununu said.

Announcement well-timed

The CMS announcement was well-timed for New Hampshire, as the clock was ticking for those on the expanded Medicaid program known as the N.H. Health Protection Plan.

Greg Moore, state director with Americans for Prosperity, points out that the state budget requires the state to enact work requirements for the Medicaid expansion population by April 30, or notify expansion recipients that the program will terminate on Dec. 31.

“Asking able-bodied adults to work is not a punishment. It’s giving them a pathway to improved quality of life, expanded opportunities and an increased sense of worth,” he said.

Vanita Gupta, president and CEO of the Leadership Conference on Civil and Human Rights, criticized the move in a statement.

“Among adults with Medicaid coverage, nearly eight in 10 live in working families and a majority are working themselves,” he said. “Adding a work requirement will only add additional bureaucracy and unnecessary administrative hurdles that will result in fewer people having health care.”

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