Medicaid Work Requirements: Policy and Practical Considerations

Prepared for the American Hospital Association

In January 2018, the Centers for Medicare & Medicaid Services (CMS) issued guidance setting forth the standards it will apply in granting state waivers conditioning Medicaid eligibility on compliance with work and community engagement requirements. Thereafter, it approved section 1115 waivers for Kentucky, Indiana, New Hampshire and Arkansas that included such requirements along with other changes to those states’ Medicaid programs. More waiver approvals will follow. This is the first time work requirements have been allowed in the Medicaid program, and at least 12 states have submitted work requirement waivers; others are considering doing so in the near future. To date, CMS has approved work/community engagement requirements only in states that have expanded their Medicaid programs to all adults with incomes below 138 percent of the federal poverty level. A handful of nonexpansion states have work requirement waiver requests pending with CMS.

In a new white paper prepared for the American Hospital Association, Manatt addresses the policy implications of conditioning Medicaid coverage on work requirements. The Manatt team identifies issues hospitals and health systems may want to raise with states when work requirements are first being considered and, if a state opts to move forward, when the state is designing the requirements.

Click here to read the full issue brief.

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