Work Requirement May Soon Help Determine Eligibility for Medicaid Benefits

For quite some time now, Medicaid has been the most widely available source of health coverage for people living across the United States. Through this program, over 72.5 million Americans, particularly disabled individuals, pregnant women, children, and seniors, were able to gain affordable health coverage. Due to recent events, however, many of them are at risk of not being able to avail of Medicaid when they would need it most.

After the recent collapse of the proposed American Health Care Act or AHCA, there has been increased interest among the Republicans to add work requirement into the eligibility for Medicaid. In fact, Department of Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma both sent letters to various state governors, giving them greater flexibility when it comes to approving Medicaid Section 1115 waivers. At the same time, these include a number of work-related proposals.

A New Proposed Work Requirement May Determine Eligibility for Medicaid

Following this, Indiana, Kentucky, Pennsylvania and Arizona have already submitted their waivers to CMS to add Medicaid work requirements. None of them have been approved yet.

Just like any other program, eligibility for Medicaid benefits is determined through a list of strict requirements, including a patient’s income, medical needs and other criteria to receive benefits. Today, however, Republicans are trying to deal with the rising costs of Medicaid by coming up with new requirements that would allow able-bodied beneficiaries to continue qualifying for the program. This may include finding work or paying for part of their health coverage itself.

22 Million Adults May Be Subject To Work Requirement

Because of this new proposal, as many as 22 million adults currently covered by Medicaid may be subject to the proposed work requirement in order to continue receiving benefits. On the other hand, there are also as many as 11 million Medicaid enrollees who would most likely lose their Medicaid coverage if the new work requirement is imposed nationwide. Interestingly enough, these include a number of people who are currently looking for work.

11 Million Stand to Lose Medicaid

Of the 11 million who stand to lose their coverage, 46 percent are said to be suffering from serious health problems such as cancer, heart disease, mental illness, diabetes and arthritis. Meanwhile, 10 percent of them are reportedly in poor health. Should their coverage be discontinued, they would suffer from an elevated risk of death.

With the possibility of these new requirements for Medicaid eligibility being imposed soon, medical institutions too should work one on one with eligibility management firms in order to help a patient determine eligibility for Medicaid in times of need. This way, Medicaid can still help pay for cost of services that a patient may be unable to afford.

Medicaid Work Requirements: Who’s At Risk?,
With Medicaid Costs Soaring, Republicans Plan Dramatic Eligibility Changes,
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Pete Ash
Pete is the Vice President of Sales & Client Services at DECO Recovery Management. He covers the Mid Atlantic region and specializes in Medicaid related topics. It is DECO’s Mission to maximize reimbursement to our clients by leveraging innovative technology, processes and compassionate advocates to provide exemplary service.

Categories: Medicaid