Earlier this week, the head of the U.S. Centers for Medicare and Medicaid, Seema Verma, travelled to Arkansas and signed a waiver request to require Medicaid enrollees to work or prepare for a job. The work requirement will only impact the expansion population, specifically childless adults 19 to 49 years old. They will be required to work or participate in activities such as volunteering or vocational training for 20 hours per week. The requirement will be phased in between June and September 2018.

CSG Midwest
The idea of requiring able-bodied adults to work or be actively seeking it as a condition for government assistance is certainly not new, but its application to Medicaid is as of January, when the Trump administration began approving some states’ applications to impose work rules as a condition of eligibility for this public health insurance program.

According to The Hill, the Senate measure approved earlier today, Jan. 22, included six years funding for the Children's Health Insurance Program, also know as CHIP.

The Children’s Health Insurance Program – also known as CHIP – has figured prominently in the deliberations on keeping the federal government open. Reporting today by Governing magazine says that the details of the vote later today have not been made public, so the fate of the six-year funding appropriation for CHIP that was included in the House continuing resolution is unclear.

Yesterday, federal officials issued new guidance that will support “state efforts to improve Medicaid enrollee health outcomes by incentivizing community engagement among able-bodied, working-age Medicaid beneficiaries.” A number of Section 1115 waiver applications currently before the Department for Health and Human Services would impose work requirements in one way or another are expected to be approved under the new policy.

CSG Midwest
An extensive new report from the Kaiser Family Foundation, “Medicaid Moving Ahead in Uncertain Times: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2017 and 2018,” provides an overview of states’ approaches to eligibility, premiums and managed care initiatives, emerging delivery system and payment reforms, long-term services and support reform, and provider rates and taxes.

On Tuesday, Nov. 7, Maine voters approved (59 percent of the vote) a ballot measure to expand Medicaid eligibility to an estimated 70,000 low-income individuals. Maine is the first state to approve Medicaid expansion through a voter referendum. It would bring the expansion total to 32 states and the District of Columbia.

Gov. Paul LePage, who has vetoed Medicaid expansion bills five times, has issued a statement saying he will not implement the measure unless the legislature fully funds it.

Today Seema Verma, administrator for the Centers for Medicare and Medicaid Services (CMS), spoke to the state Medicaid directors at their fall conference in Washington, D.C. She outlined her vision for the future of Medicaid and unveiled a number of new CMS policies during that speech and in this press release. She pledged to give states more freedom to design innovative programs and to remove federal impediments that stand in the way of states.

Maine voters will have a chance to vote on Nov. 7, 2017, whether to expand Medicaid coverage to an estimated 70,000 Mainers under the age of 65 with incomes below or equal to 138 percent of the federal poverty level. This is exactly the Medicaid expansion provision included in the Affordable Care Act.

In Virginia, the November ballot impact on health care is a little less direct, but is also being watched by political observers. All 100 House of Delegate seats are up for election. If the Democrats pick up a number of seats the legislature could approve Medicaid expansion, bringing health care insurance to 400,000 low income Virginians.

Remember that after the Affordable Care Act passed, numerous commentators predicted that increased insurance coverage, achieved through purchase of individual plans through the ACA marketplace or expanded Medicaid coverage, would precipitate a primary care shortage? Experts feared that those with new coverage would not actually have access to care and those previously insured might experience decreased access to primary care. Studies have shown that primary care availability hasn’t suffered as expected.