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Last week, the Trump administration signaled that it would allow states to impose work requirements on able-bodied recipients of Medicaid, the program that provides health care to the poor, disabled, and children of low-income parents; the administration granted the first waiver to the work-requirement prohibition to Kentucky on Friday. In November, Governor Cooper’s Department of Health and Human Services sought its own waiver, becoming one of ten states to do so. Cooper’s waiver, though, is contingent on the legislature expanding Medicaid, which it has thus far refused to do. [N&O]

  • “If North Carolina’s waiver is approved, it would apply only to people included in an expanded Medicaid program, which as we’ve pointed out would have to be approved by the General Assembly. The expansion would apply to people who are not considered disabled, between the ages of 18 and 64, and whose incomes are at or below 133 percent of the Federal Poverty Level. They are often referred to as the working poor and don’t have health insurance at work or can’t afford health insurance. To encourage the state’s Republican legislature to expand Medicaid to this group of people, Democratic Gov. Roy Cooper’s administration has included a work requirement in its Medicaid overhaul proposal.”

WHAT IT MEANS: The work-requirement initiative marks a dramatic change to the program, and likely not a good, or necessary, one. [Vox]

  • “Under current law, eligibility for Medicaid is based almost entirely on income. But the Trump administration, after months of promises, is now telling states how they can introduce a new requirement that certain Medicaid recipients also work in order to receive health coverage through the program—a move that experts say is a significant departure from the program’s purpose of providing a safety net to Americans in or near poverty.”
  • “However, several experts noted that CMS will not be providing federal resources for states to administer their work requirements. The administration may be constrained by federal law, which requires Medicaid dollars to pay for actual health care, but the result nevertheless is that states could struggle to effectively implement their work requirements and any bureaucratic snafus could result in people who need and should qualify for Medicaid coverage losing it. ‘For a state to do this, it would take enormous resources, and they’re not going to put those in,’ Judy Solomon, who follows Medicaid at the left-leaning Center on Budget and Policy Priorities, told me. ‘We know enough to know this can’t be implemented in a way that protects people. At the end of the day, it’s going to have people who need health care lose coverage.’”
  • “There is strong evidence that there is not a vast number of Medicaid enrollees who are avoiding work to stay on the program’s rolls. … The big-picture takeaway is: Most Medicaid enrollees in Michigan were working already, unable to work, or at a point in their lives where they would not work (retired or a student). Almost three-fourths of the people in the study fell into those categories.”
  • But, again, Cooper isn’t proposing a straight work requirement. Rather, that’s the carrot he’s offering the NCGA to finally expand Medicaid, which would help as many as a half-million North Carolinians access health care.