U.S. Medicaid boss defends work rules and other ‘community engagement’ requirements, says they will thwart dependency

By Al Cross
Kentucky Health News

The director of the Centers for Medicare and Medicaid Services gave a spirited defense of work rules and other “community engagement” requirements in state Medicaid programs, such as the one Kentucky officials have proposed.

“We are committed to this issue,” Seema Verma said Sept. 27 at a meeting of insurers who manage care of Medicaid beneficiaries for state governments.

She didn’t mention that the plan has been blocked by a federal judge, who said federal officials didn’t adequately consider the state’s prediction that thousands would be dropped from the rolls for failure to follow the rules or report their income and activity. But she did address those concerns.

“These policies are not blunt instruments,” Verma said. “We’ve worked carefully to design important protections to ensure that states exempt individuals who have disabilities, are medically frail, serve as primary caregivers, or have an acute medical condition that prevent them from successfully meeting the requirement.”

Kentucky’s plan would require non-exempt, “able-bodied adults” to spend 80 hours a month at work, in school, volunteering or, if needed, in drug treatment. Arkansas has adopted similar rules, and 1,000 Medicaid beneficiaries have gone to work, Verma said.

Verma cast the policies as an effort to thwart dependency on government, and cited statistics to argue that it is growing “The overall work rate for non-disabled working-age adults” has fallen by 3.4 percentage points since 2000, and the work rate of childless, working-age adults is only 2.6 points higher than the overall rate, she said. “In 1979, the employment rate for childless adults under 50 was almost 10 percentage points higher than the overall rate,” and “Not surprisingly, this group also experienced the largest increase in welfare.”

Verma said, “It is not compassionate to trap people on government programs, or create greater dependency on public assistance as we expand programs like Medicaid. True compassion is giving people the tools necessary for self-sufficiency . . . Community engagement requirements are not some subversive attempt to just kick people off of Medicaid. Instead, their aim is to put beneficiaries in control with the right incentives to live healthier, independent lives.”