Drudge Retort: The Other Side of the News
Thursday, January 11, 2018

The Trump administration issued guidance to states early Thursday that will allow them to compel people to work or prepare for jobs in order to receive Medicaid for the first time in the half-century history of this pillar of the nation's social safety net. The letter to state Medicaid directors opens the door for states to cut off Medicaid benefits to Americans unless they have a job, are in school, are a caregiver or participate in other approved forms of "community engagement" -- an idea that some states had broached over the past several years but that the Obama administration had consistently rebuffed. The new policy comes as 10 states are already lined up, waiting for federal permission to impose work requirements on able-bodied adults in the program. Three other states are contemplating them. Health officials could approve the first waiver -- probably for Kentucky -- as soon as Friday, according to two people with knowledge of the process.

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The guidance represents a fundamental and much-disputed recalibration of the compact between the government and poor Americans for whom Medicaid coverage provides a crucial pathway to health care.

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More from the article:

Trump administration has signaled from the outset that it wanted to set a more conservative tone for Medicaid, a 1960s-era program that was part of Lyndon Johnson's anti-poverty Great Society. On the day in March when she was sworn in as administrator of the Centers for Medicare and Medicaid Services, Seema Verma dispatched a letter to governors encouraging "innovations that build on the human dignity that comes with training, employment and independence." ...

Before she became the CMS administrator, Verma was a health-care consultant who specialized in helping states redesign their Medicaid programs. She was an architect of Kentucky's waiver application once a Democratic governor who had eagerly embraced the ACA was succeeded by Matt Bevin, a Republican who campaigned on a pledge to reverse the program expansion there.

www.msn.com

#1 | Posted by Gal_Tuesday at 2018-01-11 12:37 PM | Reply

The new policy comes as 10 states are already lined up, waiting for federal permission to impose work requirements on able-bodied adults in the program.
I wonder if Kansas is one of those 10 states.

#2 | Posted by Hans at 2018-01-11 12:41 PM | Reply

#2 Yes, KS is on the list of 10:

www.washingtonpost.com

#3 | Posted by Gal_Tuesday at 2018-01-11 12:49 PM | Reply | Newsworthy 1

Without researching I bet those 10 voted for Trump.

#4 | Posted by truthhurts at 2018-01-11 12:51 PM | Reply | Newsworthy 1

#3 | Posted by Gal_Tuesday at 2018-01-11 12:49 PM

Thanks, Gal.

Now I wonder if such a move will adversely affect anyone from Kansas who regularly posts here.

#5 | Posted by Hans at 2018-01-11 12:52 PM | Reply

The 10 states are: Maine, New Hampshire, North Carolina, Kentucky, Indiana, Arkansas, Kansas, Wisconsin, Utah, and Arizona.

#6 | Posted by Gal_Tuesday at 2018-01-11 12:52 PM | Reply

Wow, 9 out of 10-Maine Only.

Well I really hope those trump voters get what they voted for.

#7 | Posted by truthhurts at 2018-01-11 12:54 PM | Reply

Theoretically, I don't think having a work requirement for Medicaid is a bad idea, but practically, I wonder how it is going to work when someone with no health insurance shows up, for example, in a hospital emergency room. I'm wondering if we are going to see more instances like this one (to be fair, I don't know why this patient was dumped by security guards at a bus station, wearing only a nightgown and socks):

Man captures video of "patient dumping" outside Baltimore hospital

Overnight, Imamu Baraka was walking past a Baltimore hospital when he noticed something he says he'll never forget.

The hospital's security guards had just wheeled a patient to a bus stop, and in the freezing temperatures they left her there. The only thing she had on was a hospital gown.

"It's about 30 degrees out here right now," Baraka says in a recording of the encounter. "Are you OK, ma'am? Do you need me to call the police?" he asks.

It's called "patient dumping" and it doesn't just happen in Baltimore. In 2007, "60 Minutes" investigated the practice of removing homeless patients from Los Angeles hospitals and leaving them downtown.

www.cbsnews.com

I remember Mitt Romney saying he didn't worry about the poor in this country because we have a good safety net for them. Well, step by step, it seems Trump and the GOP are chipping away at it. I'm not sure where that's going to leave us as a country. More divided, I reckon.

#8 | Posted by Gal_Tuesday at 2018-01-11 01:01 PM | Reply

A work requirement was part of the overwhelmingly successful welfare reform of the '90's.

#9 | Posted by JeffJ at 2018-01-11 01:05 PM | Reply

8

I agree. Theoretically, I see some upside....but it depends on where you draw the line.

If we cut people off Medicaid for not complying with these standards....then what? There are people who don't give a crap about having coverage, will ignore the standards for eligibility, figure out a way to get kicked off Medicaid and then will still expect treatment.

#10 | Posted by eberly at 2018-01-11 01:08 PM | Reply

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I am wondering how this will impact the hospitals when patients with no insurance show up in the ER. If the patient doesn't work, Medicaid reimbursement won't be an option. What will hospitals do? Turn those patients away, or treat them and swallow the costs?

#11 | Posted by Gal_Tuesday at 2018-01-11 01:10 PM | Reply

11

one the largest defenses for universal healthcare is the reality that hospitals already face this issue constantly.

so my answer to your question is.......they'll handle it the same way they've been handling it. Let's try not to panic and believe we are taking millions of people off insurance by implementing these standards.

and......was this not allowed before? what exactly did Trump do here? did he de-criminalize a practice?

#12 | Posted by eberly at 2018-01-11 01:15 PM | Reply

"What will hospitals do? Turn those patients away, or treat them and swallow the costs?"

Hospitals are prohibited in denying care due to an inability to pay. It was a REPUBLICAN mandate.

In other words, republicans believe you can't force someone to be prepared for a medical emergency while simultaneously forcing everyone to pay for their medical emergency's

#13 | Posted by ChiefTutMoses at 2018-01-11 01:17 PM | Reply

A work requirement was part of the overwhelmingly successful welfare reform of the '90's.
#9 | Posted by JeffJ

A work requirement is completely at odds with a program designed to help people stay healthy and be able to work.

#14 | Posted by truthhurts at 2018-01-11 01:20 PM | Reply

"one the largest defenses for universal healthcare is the reality that hospitals already face this issue constantly."

I think one of the systemic problems that the ACA tried to address by expanding Medicaid was the issue of hospitals having to pay for uninsured and either going broke in the process or pushing the cost off onto patients who did have insurance.

#15 | Posted by Gal_Tuesday at 2018-01-11 01:22 PM | Reply

and......was this not allowed before? what exactly did Trump do here? did he de-criminalize a practice?
#12 | Posted by eberly

States have not been allowed to place requirements on Medicaid eligible individuals, i.e. beyond income requirements. This policy allows states to petition the feds to allow them to place requirements like employment, care giving, disability, training, schooling, etc. a prerequisite for eligibility. In one way it will make the program a great deal more difficult to implement, what with all the oversight that the state will need to assure compliance and eligibility.

But like usual the repubs have things backwards, a person doesn't get Medicaid for not working, they cant work because they have medical issues that require assistance.

#16 | Posted by truthhurts at 2018-01-11 01:24 PM | Reply

BTW

this is likely another one of those solutions seeking a problem

FTA

Sixty percent of Medicaid's non-elderly adults already work, according to a recent analysis of census data by the Kaiser Family Foundation. Of those without a job, more than a third are ill or disabled, 30 percent are caring for young children, and 15 percent are in school, the analysis shows.

So of the people this would target the vast majority would still be eligible for medicaid (under what would be assumed most state's eligibility requirements)

And again this will require the states have a larger oversight agency

#17 | Posted by truthhurts at 2018-01-11 01:28 PM | Reply | Newsworthy 1

I think the biggest problem here is that since Trump and the GOP couldn't repeal and replace Obamacare outright, in large part because they had no replacement plan, they are trying to undo the current health care system piecemeal, but still without a replacement plan and without looking at how these incremental changes are going to impact the whole. The whole being 20 to 25% of our economy.

#18 | Posted by Gal_Tuesday at 2018-01-11 01:28 PM | Reply

"(under what would be assumed most state's eligibility requirements)"

Won't states have the right to determine those as well?

#19 | Posted by Gal_Tuesday at 2018-01-11 01:30 PM | Reply

"(under what would be assumed most state's eligibility requirements)"
Won't states have the right to determine those as well?
#19 | Posted by Gal_Tuesday a

Yes, but presumably they will meet some logical standard, like not requiring pregnant mothers with sick parents at home to get a job and presumably they will have to get approval from the feds for their eligibility requirements.

As I read the article the "exceptions" to the eligibility requirements as being enormous struck me.

#20 | Posted by truthhurts at 2018-01-11 01:34 PM | Reply

16

I agree, especially that it will cost more to administer just to find out there aren't very many folks who won't be able to continue to be eligible.

#21 | Posted by eberly at 2018-01-11 01:39 PM | Reply

Figure the oversight will be something like that for unemployment benefits, but on steroids.

FTA

Under Kentucky's waiver application, for instance, people on Medicaid would be required to report income changes within 10 days, noted Cara Stewart of the Kentucky Equal Justice Center. For low-wage workers, such as waitresses with fluctuating wages, "it boggles my mind," Stewart said.

People have to review and verify all this information.

#22 | Posted by truthhurts at 2018-01-11 01:42 PM | Reply

#11 it's the same option C as pre-ACA Times.

They treat and pass the costs on to insured patients.

#23 | Posted by jpw at 2018-01-11 01:49 PM | Reply

Under Kentucky's waiver application, for instance, people on Medicaid would be required to report income changes within 10 days, noted Cara Stewart of the Kentucky Equal Justice Center. For low-wage workers, such as waitresses with fluctuating wages, "it boggles my mind," Stewart said.

To cut down on the paperwork, states will probably set up a policy that says: if you lose your Medicaid eligibility, you can't reapply for X (30, 60, 90?) number of days.

#24 | Posted by Gal_Tuesday at 2018-01-11 02:00 PM | Reply

"it will cost more to administer just to find out there aren't very many folks who won't be able to continue to be eligible.
#21 | POSTED BY EBERLY

In the other thread I was thinking you, Eberly, are one of the three Republicans with sufficient fiscal literacy to see that this will drive up costs.

(Three may be generous; but I didn't want to place you on an island. )

(Apologies if you don't like being called "Republican," I can't really tell what political gender you identify as these days, so I'm just going off memory.)

#25 | Posted by snoofy at 2018-01-11 02:21 PM | Reply

To cut down on the paperwork, states will probably set up a policy that says: if you lose your Medicaid eligibility, you can't reapply for X (30, 60, 90?) number of days.

#24 | Posted by Gal_Tuesday

So if you are too ill to work and you have no healthcare you have to get a job so you can get the healthcare you need to get well enough to work.

Why that sounds like such a well thought out plan!

#26 | Posted by donnerboy at 2018-01-12 04:46 PM | Reply

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