Medicaid is a 1960s-era Lyndon Johnson anti-poverty Great Society government program that provides free health insurance (as well as benefits not normally covered by Medicare, like nursing home care and personal care services) to low-income adults, their children, and people with disabilities, totaling 74 million recipients in 2017. Jointly funded by the state and federal governments, Medicaid is managed by the states, with each state currently having broad leeway to determine eligibility. Although states are not required to participate in the program, all have since 1982. Medicaid recipients must be U.S. citizens or legal permanent residents.
The Affordable Care Act, i.e., Obamacare, significantly expanded both federal funding and eligibility for Medicaid, to include all U.S. citizens and legal residents with income up to 133% of the poverty line.
The U.S. Department of Health and Human Services (HHS) determines the poverty thresholds, updated each year by the Census Bureau. For the 2017 poverty thresholds, go here. As an example, the poverty threshold for a family of four is $24,600. That means a family of four with an annual income of $32,718 (133% of $24,600) or lower is eligible for Medicaid.
Like Medicare and Social Security, the federal government’s spending on Medicaid has burgeoned since the 1990s. If nothing is done, Medicaid spending will balloon to $1½ trillion in 2022.
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The Trump administration has signaled from the outset that it wanted to set a more conservative tone for Medicaid. On the day in March when she was sworn in as administrator of the Centers for Medicare and Medicaid Services (CMMS), Seema Verma dispatched a letter to governors encouraging “innovations that build on the human dignity that comes with training, employment and independence.”
Currently, 10 states intend to impose work requirements on able-bodied adults who are receiving Medicaid, but they need federal permission to do so. The 10 states are Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin. Three other states are contemplating the work requirement — Alabama, Idaho, and South Dakota. (Washington Post)
Today, the Trump Administration issued a letter to state Medicaid directors which, for the first time in Medicaid’s half-century history, enables states to cut off Medicaid benefits to Americans unless they have a job, are in school, are a caregiver or participate in approved forms of community service — an idea that the Obama administration had consistently rejected.
To those who, predictably, will accuse President Trump of hard-heartedness, the letter specifies that:
“States must comply with federal civil rights laws, ensure that individuals with disabilities are not denied Medicaid for inability to meet these requirements, and have mechanisms in place to ensure that reasonable modifications are provided to people who need them.States must also create exemptions for individuals determined by the state to be medically frail and should also exempt from the requirements any individuals with acute medical conditions validated by a medical professional that would prevent them from complying with the requirements . . . . As many Medicaid beneficiaries live in areas of high unemployment, or are engaged as caregivers for young children or elderly family members, states should consider a variety of activities to meet the requirements for work and community engagement . . . . States will be required to describe strategies to assist beneficiaries in meeting work and community engagement requirements and to link individuals to additional resources for job training or other employment services, child care assistance, transportation, or other work supports to help beneficiaries prepare for work or increase their earnings.”
CMMS could approve the first Medicaid work requirement waiver — probably for Kentucky — as soon as tomorrow!
Please keep President Trump in your prayers.