HHS Announces New Rules for Medicaid Expansion Waivers

This week HHS announced new rules for Medicaid expansion waivers.The new rules notably allow states expanding Medicaid to implement work requirements.^[1][2]

Work requirements are favored by Republicans, with the idea being that they get those on Medicaid back to work.

However, work requirements are criticized by Democrats for indirectly targeting those who can’t find employment or for who employment is not an option (like the homeless or people living in regions where there is a lack of jobs).

About 75% of families on Medicaid are working families, and only some states will likely implement work requirements, but in those states, the worry is that strict rules will result in some of our most medically needy losing access to Medical care because they cannot work.

With that said, states that will choose this path tend not to have expanded Medicaid in the first place. Thus, any expansion (even with work requirements) can be seen as a plus.

The issue is complex.

Learn more about the ongoing debate over Medicaid and work requirements.

Learn more about the new HHS rules from the Washington Post’s The Health 202: Work requirements are on their way for Medicaid.

According to Talking Points Memo:

HHS’ new criteria for the Medicaid waivers are as follows:

• Improve access to high-quality, person-centered services that produce positive health outcomes for individuals;
• Promote efficiencies that ensure Medicaid’s sustainability for beneficiaries over the long term;
• Support coordinated strategies to address certain health determinants that promote upward mobility, greater independence, and improved quality of life among individuals;
• Strengthen beneficiary engagement in their healthcare plan, including incentive structures that promote responsible decision-making;
• Enhance alignment between Medicaid policies and commercial health insurance products to facilitate smoother beneficiary transition; and
• Advance innovative delivery system and payment models to strengthen provider network capacity and drive greater value for Medicaid.

The criteria under the Obama administration, however, was entirely different:

• increase and strengthen overall coverage of low-income individuals in the state;
• increase access to, stabilize, and strengthen providers and provider networks available to serve Medicaid and low-income populations in the state;
• improve health outcomes for Medicaid and other low-income populations in the state; or
• increase the efficiency and quality of care for Medicaid and other low-income populations through initiatives to transform service delivery networks.

The difference: The difference is the Republican-run HHS under Trump is focused on getting people off of Medicaid and back into the private market, while the Democratic-run HHS under Obama was focused on improving health outcomes, covering more people, and stabilizing Medicaid.

1. Kaiser Family Foundation’s Medicaid and Work Requirements
2. the Washington Post’s The Health 202: Work requirements are on their way for Medicaid