CMS Issues Guidance for States Requesting Work Requirements for Medicaid Beneficiaries

By Susan Jones | January 11, 2018 | 11:38 AM EST

( - The Centers For Medicare and Medicaid Services on Thursday announced guidance for states wishing to impose work requirements or other "community engagement" activities for able-bodied, working-age Medicaid beneficiaries.

"Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today’s announcement is a step in that direction,” said Seema Verma, CMS Administrator.

CMS said so far, ten states (Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin) have submitted proposals for projects that would require certain Medicaid beneficiaries to either get jobs, look for work, or otherwise contribute to society through volunteering or caregiving.

The requirements would not apply to the seriously disabled, elderly, children, or pregnant women.

States will be required to offer "reasonable modifications" to individuals with disabilities, and states must exempt individuals determined to be medically frail or who have an acute condition that a medical professional has determined will prevent them from complying with the requirements.

CMS also will require states to make "reasonable modifications" for individuals with opioid addiction and other substance use disorders. These modifications may include counting time spent in medical treatment toward an individual’s community engagement requirements; or exempting individuals participating in intensive inpatient or outpatient medical treatment.

“States have the opportunity to help individuals improve and enhance the skills that employers truly value,” said Verma. “People who participate in activities that increase their education and training are more likely to find sustainable employment, have higher earnings, a better quality of life, and, studies have shown, improved health outcomes.”

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects determined by the Secretary to be likely to assist in promoting the objectives of the Medicaid program.

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