Slow Down Medicaid-for-Work Approvals, Federal Advisers Urge

By Victoria Pelham

Federal advisers will ask the Trump administration to hold off on approving controversial Medicaid work requirements, an advisory panel decided Oct. 25.

The new rules tie Medicaid eligibility to maintaining a job, pursuing education, or volunteering. Members of the Medicaid and CHIP Payment and Access Commission also want Arkansas, the first state to roll out the sweeping eligibility overhaul, to slow down implementation while they build in more safeguards for beneficiaries.

Implementation of sweeping Medicaid overhauls is always difficult but less so with more time and more data, Commissioner Christopher Gorton said. Gorton is the former president of public plans at Tufts Health Plan.

“Let’s do it right,” he said. “Let’s hit the pause button, not forever or in response to what we’re seeing in Arkansas, simply because we’re not ready to dance here.”

The panel, which advises Congress and health-care officials, plans to detail its concerns in a letter to Health and Human Services Secretary Secretary Alex Azar.

The move could make waves for a plan the Trump administration has aggressively backed as a chance to strengthen Medicaid enrollees’ independence by getting them back to work and improving their health. It could also sway federal lawmakers’ minds as a flood of other states try to implement work requirements.

Indiana and New Hampshire already have the go-ahead to impose Medicaid work requirements, and at least 11 states have requests pending, according to the Centers for Medicare & Medicaid Services.

Gaps Found in Arkansas

MACPAC warned in its strongest stance to date that Arkansas’ work rules experiment is plagued by design holes. The gaps mean it’s just not working well, commissioners said. They cited concerns over the state’s imposition of dramatic changes in a very short time period and its requirement that beneficiaries report their hours online in a state with limited internet access.

The Natural State booted nearly 8,500 from Medicaid since this summer for failing to comply with the work rules, according to Oct. 15 figures from the Arkansas Department of Human Services. That’s out of the 73,266 people subject to the rules in the state.

Commissioner Alan Weil said at the Oct. 25 meeting that it is “very difficult” for him “to simply say we’re going to wait, we’re going to see how many more people lose coverage.”

Federal health-care officials should boost oversight and strengthen evaluations of the work rules while they press pause on the program, the commissioners said. They should also take a closer look at outreach and try to raise awareness among Medicaid enrollees of the new rules.

Trump Administration Resolve

Arkansas’ struggles to keep Medicaid enrollees in the program haven’t weakened the Trump administration’s resolve.

“We have a very strong commitment” to work engagement programs, HHS Office of Health Reform Director Jim Parker said Oct. 17. Parker, also a senior adviser to Azar, made the comments at the America’s Health Insurance Programs National Conference on Medicaid.

“We think it’s not only an effective flexibility tool, but it also represents something we hold very dear, which is giving individuals the opportunity or perhaps the nudge they may need within their communities to continue personal betterment and advancement,” he added.