The Trump administration on Friday said Kentucky can require Medicaid recipients to work as a condition of coverage, barely pausing for a breath after it laid out a welcome mat Thursday for states that want to force able-bodied people off the rolls unless they find jobs, volunteer or meet other conditions.
Gov. Matt Bevin, a Republican, said federal approval of their waiver program — the first of its kind — will be “transformational” for his state, shoring up benefits for pregnant women and the truly infirm while prodding healthy people to lift themselves out of poverty.
“They are not stupid people. These are not incapable people,” Mr. Bevin said.
The project, known as Kentucky HEALTH, will require many adults on Medicaid to perform 20 hours of work, job training or community engagement per week and imposes monthly, income-based premiums of $1 to $15 per month.
Nine other states have requested work-requirement waivers from the administration — Arizona, Arkansas, Indiana, Kansas, Maine, New Hampshire, North Carolina, Utah and Wisconsin.
Yet Kentucky has been waiting the longest. It applied for changes to its Medicaid program, which covers 1.4 million poor, disabled or elderly people, in August 2016.
President Obama, who vastly expanded Medicaid to more able-bodied adults, frowned on work requirements, but the Trump administration took the opposite view, culminating in guidance that encouraged states to find ways to lift people off the government dole.
Kentucky’s approval will likely spark a legal challenges from advocates who say extra conditions might knock people off their insurance, contravening Medicaid’s mission to extend coverage to the needy.
Indeed, it’s a major policy change for Medicaid, an outgrowth of the Great Society programs ushered in by President Lyndon B. Johnson a half century ago.
Yet Seema Verma, administrator for the Centers for Medicare and Medicaid Services, said working makes people healthier, so she’s operating within her authority. Work requirements have been attached to other safety-net programs, like food stamps.
Kentucky expects nearly 97,000 fewer people to hold Medicaid coverage after five years, as enrollees move into jobs or fall off the rolls due to noncompliance. Enrollees who fail to pay their premiums after a 60-day grace period or fail to report changes in employment or income can be barred from Medicaid for six months.
The development is a major turnabout from just four years ago, when Democrats praised Kentucky for fully embracing Obamacare even as other southern states balked. Then-governor Steve Beshear, a Democrat, set up the state’s own insurance exchange, dubbed “kynect,” and expanded Medicaid under the law, yet his Republican successor decided to unwind both.
Rep. John Yarmuth, Kentucky Democrat, accused Mr. Bevin of sabotaging the program because he “did not have the courage” to end Obamacare’s expansion.
“Make no mistake: people will die because of this,” he said.
CMS argues it won’t accept waivers that hurt the truly needy. It told states to steer clear of plans that punished the disabled or others suffering hardships, such as opioids addictions, saying it didn’t want to punish people but rather entice those who could be working to get back into the job market.
Critics doubted the Trump administration’s assurances that the disabled would be spared, and said yanking their health care would make it even harder for them to find work, especially in physically demanding jobs.
Capitol Hill Democrats also said pushing people to work could backfire since many Medicaid recipients already work and might fumble their paperwork when new rules take effect.
Senior Democrats on the House Energy and Commerce and Senate Finance committees asked a chief watchdog on Friday to monitor whether the Medicaid waiver projects comply with federal law.
“The Medicaid program serves beneficiaries; evaluation of any demonstration before, during and subsequent to implementation must operate from that standpoint,” Rep. Frank Pallone of New Jersey and Sen. Ron Wyden of Oregon wrote to the Government Accountability Office. “As part of your ongoing work, we believe that GAO should continue to review the compliance of states and the federal government with existing law as part of its ongoing work and advise Congress on needed improvements to public transparency and accountability.”
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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