Kentucky becomes first state to receive approval for Medicaid wo

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Stephen Miller, the Medicaid commissioner for Kentucky, which received authority Friday to implement a work requirement, said the new policy will "allow states the flexibility to pursue innovative approaches to improve the health and well-being of Medicaid beneficiaries".

Kentucky got the green light from the federal government Friday to require people who get Medicaid to work.

However some IL patient advocates say they hope the state doesn't submit a proposal to make having a job a condition of Medicaid eligibility, citing fears it would leave people without health insurance.

The red tape associated with work requirements also adds a new burden on the agencies that administer Medicaid benefits, Musumeci noted. "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". The federal government, however, leaves the qualifying characteristics up to states. In practical terms, they would represent new requirements for beneficiaries in those states.

For people in exceptionally vulnerable positions - say, someone who just lost his job after failing a drug test and can't find an available space at a substance abuse program in his area - adding another bureaucratic hurdle could make it even more hard to get back on track.

Officials acknowledge that the work requirement - coupled with other changes in its waiver request - would lead to about 95,000 fewer people enrolled after five years.

"This is an effort to walk back the Medicaid expansion", said Judith Solomon, vice president of the Center on Budget and Policy Priorities, a Washington-based research organization. Most who are not working report reasons such as illness, caring for a family member or going to school.

Even if people in treatment, or with other circumstances that prevent them from working, are legally entitled to an exemption under state rules, another big issue is how many hoops they'll have to jump through to keep getting medical care.

In addition to the large group of enrollees already working, the federal guidelines excluded children - who make up almost half of Medicaid enrollees.

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Conservatives, however, hailed the change to the federal-state program for low-income people.

"Should eligible Medicaid recipients be looking for work or be trying to work?"

But Senate Health and Human Services Appropriations Chairwoman Anitere Flores, R-Miami, said the Senate has not discussed requiring those now enrolled in the program to work.

The CMS announcement was well-timed for New Hampshire, as the clock was ticking for those on the expanded Medicaid program known as the N.H. Health Protection Plan.

In comparison, Kentucky seeks to exempt children; pregnant women; primary caregivers for children or a disabled relative; people who are medically frail; and full-time students.

"The thought that a program designed for our most vulnerable citizens should be used as a vehicle to serve working-age, able-bodied adults does not make sense", she said at the time. They will need to "see all of details from states", he said.

The conditions would exclude individuals eligible for Medicaid due to disability, elderly beneficiaries, children and pregnant women.

ME is one of ten states asking for a waiver from the Federal Department of Health and Human Services. "Such programs may also, separately, be created to help individuals and families rise out of poverty and attain independence, also in furtherance of Medicaid program objectives".