“Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration. Those days are over,” said Seema Verma, referencing the Trump administration's plan to impose work requirements for Medicaid recipients. She spoke at the National Association of Medicaid Directors annual meeting in Arlington, Va., where she laid out the Trump administration’s goals for the Medicaid program.
Verma said the administration would be more likely to impose what is often referred to as “work requirements,” though these programs tend to also include encouraging Medicaid enrollees to take classes, undergo job training or do volunteer work. States increasingly have been asking the federal government for the right to make these sorts of changes as they administer Medicaid. Typically, the work requirements contain exemptions for people with disabilities, children, pregnant women and older adults in nursing homes.
Verma praised the programs and told those in the room, a crowd of about 1,000 people that included Medicaid directors, that they could expect to move forward with them.
“Let me be clear to everyone in this room,” Verma said. “We will approve proposals that promote community engagement activities. Every American deserves the dignity and respect of high expectations and as public officials we should deliver programs that instill hope and say to each beneficiary that we believe in your potential.”
Obamacare was originally written to expand Medicaid to low-income people in every state who make less than $16,643 for an individual. This portion of the law, however, was changed by the Supreme Court, making it optional for states. As a result, about 11 million people have received coverage through Medicaid expansion, and 19 states have not expanded the program.
The Obama administration allowed some flexibility on Medicaid expansion, including on a program that Verma helped Indiana develop in her former role as a private consultant when Vice President Mike Pence was governor of Indiana. The program included contributions by beneficiaries.
Verma stressed during her speech that the Trump administration’s position was that Medicaid should be for the most vulnerable citizens, such as people with disabilities, and that it otherwise should be used as a leg up for people to “rise out of poverty and government dependence.” The goal to “hand out Medicaid cards,” she said, was inadequate. She bemoaned that a third of doctors do not accept Medicaid patients and said that spending was being diverted from state programs like education and economic initiatives to fund Medicaid.
“Our safety net should be stronger to ensure no deserving Americans fall through the cracks,” she said. “We can and we must serve them better.”
States vary significantly in where they stand on these issues, and the topic of rolling back Obamacare’s Medicaid expansion played prominently during the failed Republican attempt to dismantle the law.
The Obama administration said it was against the mission of the program to implement work requirements. Several Republican-led states have asked for Medicaid work requirements, including Arizona, Kentucky and Pennsylvania, according to the Kaiser Family Foundation.
Verma signaled that the administration would be more flexible for states so they could design their own programs.
“Past administrations haven’t always accepted this diversity, and instead imposed a Washington-knows-best, one-size-fits all Medicaid policy,” she said. “And maybe that’s why Medicaid has faced problems for decades: problems with access, problems with quality and problems with program integrity.”
The program should have been fixed, she argued, rather than increasing Medicaid rolls through Obamacare.