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Medicaid Work Requirements (Updated January 18, 2018)

Medicaid Work Requirements (Updated January 18, 2018)

This Update is intended to serve as an interim analysis of the Medicaid Work Requirements being encouraged and approved by the Trump Administration and CMS.  It is anticipated that these requirements will evolve over time and will most likely expand to additional states. Two helpful websites for additional information are healthinsurance.org and the Kaiser Family Foundation.

Medicaid Work Requirement Approvals

On January 11, 2018, the Centers for Medicare and Medicaid Services announced a new policy under the Trump administration regarding community engagement for able-bodied adults enrolled in Medicaid. A letter was sent the same day to all state Medicaid Directors detailing the new policy, which will allow states to require working-age, non-pregnant, non-disabled individuals to be engaged in work or other “community engagement activities,” including skills training, education, job searches, volunteering or caregiving as a condition for Medicaid eligibility.

Kentucky’s New Medicaid Work Requirements

Implementing the new CMS policy, Kentucky’s work requirement proposal was approved on January 12, 2018, becoming the first state to obtain approval for a Medicaid work requirement. The majority of the regulations, called Kentucky HEALTH, will go into effect July 1, 2018. Under the new requirements, adults age 19 to 64 must complete 80 hours of community engagement a month, including work, school, training or volunteering to maintain their eligibility, unless they meet a specified exemption. Exemptions include a disability, pregnancy, full time students, former foster care youth, and primary caregivers. Beneficiaries will have their eligibility suspended for failure to demonstrate compliance with the community engagement requirement, but will be able to reactivate their eligibility on the first day of the month after they complete 80 hours of community engagement in a 30 day period, or the completion of a state-approved health literacy or financial literacy course. Beneficiaries who are in an eligibility suspension and fail to meet the requirements by their redetermination date will have their enrollment terminated and will be required to submit a completely new application. Good cause exemptions relating to termination of benefits may be allowed under certain circumstances.

Dental and vision insurance, which is currently covered by Kentucky Medicaid will be eliminated. However, these services may be earned back through a rewards system called My Rewards Account, with enrollees earning credit through incentives like getting an annual physical or completing a diabetes, weight management, or anti-smoking program. Enrollees may start earning credit beginning April 1, 2018.

Additionally, enrollees will be required to pay premiums based on their income, which will range from $1 to $15 a month. Individuals with income above the poverty level (100-138% FPL) who do not pay premiums for 60 days will be locked out of the program for 6 months.

Able-bodied individuals will also have a $1,000 “deductible.” Non-preventative services will be tracked against the $1,000 balance in each member’s “deductible account.” At the end of the year, up to 50% of the remaining balance of the deductible will be transferred to the members My Rewards Account. Enrollees who use the entire $1,000 will still be able to access medical care for the remainder of the year and will not owe anything out of pocket.

Finally, retroactive eligibility will no longer be available for Kentucky HEALTH enrollees, except for pregnant women, children under 1 year old and former foster care youth.

Other Proposed State Requirements

At the time of the CMS release, ten states had proposals that included a work requirement: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina (the waiver includes language regarding a state bill that would contain the requirement), Utah, and Wisconsin. Mississippi has also submitted a waiver request to CMS, but it is not yet been certified as complete. Several states are already in the process of drafting waiver proposals to include a work requirement, and it is anticipated that many additional states will follow suit after CMS’ announcement. It is possible that the work requirements will make some individuals financially ineligible for Medicaid in states with low eligibility levels for adults, as the mandatory work hours, at a minimum wage, will result in an income above the Medicaid maximum.

For additional information about the current Medicaid Work Requirement Waiver Proposals, check out this chart on the Kaiser Family Foundation website»


MedData Disclaimer – This document is provided for general informational purposes only and is not intended as legal advice. The providing of the information in this document is neither intended to establish an attorney-client relationship nor to expand the existing contractual relationship with MedData. MedData would recommend that you consult with your own internal legal resources before taking any action in reliance on this information.

Doug Turek

Mr. Turek is Senior Vice President of Regulatory and Governmental Affairs for MedData and has been a licensed attorney in Texas for nearly 20 years. Mr. Turek is also licensed in Utah, California, Nevada, Oklahoma, Pennsylvania, and Missouri.

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