Kentucky has proposed requiring certain Medicaid recipients to complete 80 hours a month of work or “community engagement,” such as job training or volunteering. | Courtesy of Pixabay

The Trump administration Thursday re-affirmed its commitment to work requirements like the one that Kentucky wants to impose on certain “able-bodied” Medicaid recipients and clapped back at critics.

Seema Verma, the administrator of the U.S. Centers for Medicare & Medicaid Services (CMS), expressed strong support while speaking at a Medicaid Managed Care Summit in Washington, D.C.

“When you consider that, less than 5 years ago, Medicaid was expanded to nearly 15 million new working-age adults, it’s fair that states want to add community engagement requirements for those with the ability to meet them,” she stated in her prepared remarks. “It’s easier to give someone a card. It’s much harder to build a ladder to help people climb their way out of poverty. But even though it is harder, it’s the right thing to do.”

Seema Verma

Verma’s speech came just a few weeks after CMS took comments from the public on Kentucky’s Section 1115 Medicaid waiver, attracting more than 11,500 online responses. The overwhelming majority of them were against the proposal.

“This waiver is a thinly veiled effort to punish the poor,” wrote one respondent. “Requiring work is a ruse to reduce the utilization of Medicaid with the attendant damage to the overall health of citizens.”

But Verma said, “Community engagement requirements are not some subversive attempt to just kick people off of Medicaid. Instead, their aim is to put beneficiaries in control with the right incentives to live healthier, independent lives.”

Back in January, Kentucky became the first state in the nation to receive approval for its plan after the Trump administration signaled that it would allow states to impose work requirements as a condition for coverage.

But the Medicaid demonstration project, better known as Kentucky HEALTH, was sidelined by a legal challenge that led to the approval being vacated and the plan being sent back to U.S. Health and Human Services for further review.

Calling the approval “arbitrary and capricious,” U.S. District Judge James Boasberg said the U.S. Health and Human Services secretary had neglected to consider whether the program would help provide medical assistance to the state’s citizens, one of Medicaid’s main objectives.

Despite the setback, Verma said, “We are committed to this issue, and we are moving closer to approving even more state waivers. As such, I’m happy to share with you today that we have finalized the terms for our next innovative community engagement demonstration, which we expect to deliver to the state very soon. So stay tuned!”

A CMS spokesman indicated after the speech that Kentucky’s waiver is still under review. The summit agenda included a presentation on Kentucky HEALTH by members of the state Cabinet for Health and Family Services.

Verma, the keynote speaker, rejected the notion that programs like Kentucky HEALTH reflect a lack of compassion for low-income people who receive Medicaid.

“It is not compassionate to trap people on government programs, or create greater dependency on public assistance as we expand programs like Medicaid,” Verma said. “True compassion is giving people the tools necessary for self-sufficiency … allowing able-bodied, working-age adults to experience the dignity of a job, of contributing to their own care and gaining a foothold on the path to independence.”

She also noted that the waivers have certain protections built in.

“These policies are not blunt instruments. We’ve worked carefully to design important protections to ensure that states exempt individuals who have disabilities, are medically frail, serve as primary caregivers, or have an acute medical condition that prevents them from successfully meeting the requirement,” Verma said.

Soon after Kentucky’s waiver was initially approved, a lawsuit was filed by more than a dozen Medicaid recipients who argued, among other things, that the proposal would endanger the health care of tens of thousands of low-income families.

Affected adults would have to complete 80 hours a month of work or “community engagement,” such as volunteering or job training, to keep their benefits. Kentucky HEALTH also would include premiums, lockouts, online reporting of hours and a My Rewards feature to earn virtual dollars for things like routine dental and vision care.

Critics have argued that the complexity of the waiver and stumbling blocks, such as lack of internet access, will result in many people losing much-needed insurance coverage as is already happening in Arkansas.

But Verma said, “The problem too often is that the most well-meaning government policies trap people in a hopeless cycle of poverty, making it too difficult to escape and too easy to become more dependent.  Instead, we ought to insist that the able-bodied participate in earning benefits.”

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Darla Carter
Darla Carter is a hometown girl who recently joined the staff of Insider Louisville to mostly cover health. She previously served as a longtime health and fitness writer for The Courier-Journal, where she also worked for the Metro, Neighborhoods and Features departments. Prior to that, the award-winning journalist wrote for newspapers elsewhere in Kentucky and Tennessee, covering a range of topics, from education to courts. She's a graduate of Western Kentucky University, where she studied journalism and philosophy, and is the proud mom of two young children.