Millions of Americans will see changes to their health care in the coming years. Following the passage of the GOP tax plan, insurance premiums will rise an average of $1,500 for people with ACA coverage between the ages of 50 and 64. That price hike starts in 2019. Other changes will come earlier, beginning in 2018.
For example, Medicare beneficiaries have caps on how much therapy they can receive as of January 1. Until Congress provides a solution, physical therapy and speech-language pathology (e.g., for stroke patients) have caps set at $2,010 per year. Patients in need of therapy beyond that cost will need to find a way to pay for such treatment.
Meanwhile, changes to Medicaid are also coming for 2018. On January 12, the Trump administration approved the first-ever work requirement for Medicaid recipients in Kentucky. The day before, officials announced they would grant exceptions of this kind to many state governments.
Drug screening, elimination of retroactive coverage, and asset tests could also enter the picture this year. However, work requirements could be first to launch in 10 states following the White House ruling. Here’s what Medicaid recipients should know and which states could impose these restrictions in 2018.
What ‘work requirements’ mean
In Kentucky, the new rules will require Medicaid recipients to work 80 hours per month, The Washington Post reported. Volunteer work and job training may also count, and the rules will apply to able-bodied adults who are old enough to work. Anyone who does not meet the requirement will receive a notice giving them one more month to do so.
After the second month passes, Medicaid beneficiaries who don’t satisfy the obligation would lose their benefits. Kentucky, which cut down the state’s uninsured ranks dramatically under the program’s ACA expansion, has approximately 350,000 people who will be subject to the work requirements, the governor’s office said January 12.
According to Kaiser Family Foundation (KFF), most Medicaid recipients of a working age don’t work for clear reasons. Some 35% cannot due to an illness or disability, while another 28% can’t because they are caring for family members or a property. There may be some gray areas for the “able-bodied” suffering from mental problems as well.
Next: This state will be the new lab for Medicaid eligibility, and 95,000 may lose health care.
The list begins with Kentucky, the first state in the history of Medicaid to get approval to deny health care coverage for work-related obligations. Matt Bevin, the state’s Republican governor, described the proposed changes to the health care program “transformational.” Indeed, residents will see many new provisions in his state’s health care laws.
According to an analysis by Andy Slavitt, the former head Medicaid administrator, other changes coming to Kentucky Medicaid policy have nothing to do with work:
- Some of the poorest Americans will have to pay premiums.
- Those who lose coverage will have to pass “a health literacy or financial literacy course” to get treatment.
- Medicaid enrollees will lose coverage for six months when they fail to meet requirements.
Kentucky officials said about 95,000 people would lose coverage under the new requirements.
Next: This state hopes to add drug testing as well as work requirements.
Scott Walker, the Republican governor of Wisconsin, hopes to get work requirements as well as drug screening in place. Wisconsin’s waiver request remains pending, but we’ll see if the Kentucky decision speeds this application along.
As for Walker’s drug testing idea, Missouri’s effort on that front cost $336,297 to get 48 positive tests a few years back. If a state is trying to make its Medicaid program more efficient, such testing does not seem to work. After all, a lower percentage of Medicaid beneficiaries use drugs when compared to the rest of the population.
Next: The Trump administration hired the official who handled this state’s Medicaid program.
Seema Verma, who heads the Centers for Medicare and Medicaid Services (CMS) under Trump, had Vice President Mike Pence applauding when she announced the change to policy on January 11. Verma helped craft Indiana Medicaid policy under Governor Mitch Daniels and, later, Pence. Following the administration’s announcement, Indiana administrators said they expect approval for the state’s own work requirements “soon.”
Next: In a state where voters approved a Medicaid expansion, work requirements could also follow.
Following years of Maine Governor Paul LePage blocking Medicaid expansion, state voters overruled him in a 2017 referendum. LePage said he’ll maneuver to block that expansion and hoped to begin work requirements as well. Maine’s request for waiver approval on this count remains pending in Washington D.C. The governor’s requests for savings account data and other personal financial records of Medicaid beneficiaries also sit on hold.
Next: This state hopes to join Kentucky with Medicaid work requirements and begin charging for coverage.
While work requirements get most of the headlines, Utah’s move to charge the state’s poorest Americans for treatment might be just as controversial. Premiums will start between $1 and 15, officials said. (Those who fail to pay would see premiums double.) Obviously, those who qualify for Medicaid are among the country’s poorest, but Utah hopes to join Kentucky with work requirements and new premiums 2018. The state’s request is pending.
Next: Though not technically a part of Medicaid expansion, Carolina Cares involves a work requirement.
6. North Carolina
Though North Carolina will not be named among the 10 states looking for a work requirement, the Carolina Cares program includes one. According to North Carolina Health News, this feature became part of state policy when legislators filled the Medicaid “gap.” Coverage goes to those making too much to qualify for the federal program yet not enough to qualify for Obamacare subsidies.
Greg Murphy (R-Greenville) explained the philosophy of North Carolina legislators who passed the program. “This was the problem with the ACA’s original inception: It allowed able-bodied individuals who could be working or could seek work to get health insurance,” Murphy said.
Next: In one of America’s worst-run states, work requirements are on the table.
No one will look to Kansas for an example of sound fiscal policy. Governor Sam Brownback’s 2012 tax cuts were such a failure the state had a $900 million budget shortfall in 2017. (In what D.C. Republicans hope does not play out nationally, a tax hike followed last year after economic growth stalled.) Nonetheless, Kansas believes work requirements and other eligibility restrictions will improve Medicaid. The state’s request may be approved soon.
Next: One of Utah’s neighbors hopes for Medicaid work requirements as well.
The senate race in Arizona could be among the most hotly contested elections of 2018. With Senator Jeff Flake retiring and recently pardoned Joe Arpaio joining the field, analysts give Democrats their best chance there in years. The state’s position on Medicaid may fuel even more opposition momentum ahead of midterms. Like neighboring Utah, Arizona hopes to require work and other conditions for eligibility this year.
Next: Maine’s southern neighbor hopes to join the ranks, too.
9. New Hampshire
Expect a great deal of debate on New Hampshire Medicaid expansion when the program comes up for renewal in 2018. At the statehouse, Governor Chris Sununu said changes would come. Meanwhile, state officials wait on a request for Medicaid work requirements following Kentucky’s approval. How this plays out will definitely impact the governor’s election in November.
Next: After removing 80,000 people from the Medicaid rolls in ’17, work requirements could thin the ranks more.
Some 80,000 lost Medicaid coverage in Arkansas following the state’s review of eligibility requirements in 2017. If new employment rules become part of the package, those ranks may shrink even more. Kaiser Family Foundation data shows Arkansas waiting on approval for eligibility tests on several levels. The January 11 decision at the federal level and January 12 approval of Kentucky’s request could accelerate the process.
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