Healthcare and advocacy organizations are reacting to the Centers for Medicare & Medicaid Services’ (CMS) interim final rule requiring “80 hours per month of qualifying activities, such as employment, participation in certain work programs, or community service, or be enrolled in educational program at least half time” for adults from 19 to 64 years old who are Medicaid enrollees without qualifying exemptions.
CMS issued the interim final rule on June 1. Comments are being accepted through July 31, the day the provisions also go into effect.
The agency added, that states “must generally implement this requirement no later than Jan. 1, 2027.”
LAC: Rule goes beyond CMS’s authority
The Legal Action Center (LAC), a national nonprofit public policy organization, said in a June 2 announcement that it “strongly opposes the interim final rule implementing the Medicaid work requirements enacted through last year’s federal budget reconciliation law, H.R. 1. The rule imposes restrictions that exceed the agency’s statutory authority and will inevitably cause far more than the 5.3 million people initially projected by the Congressional Budget Office to lose Medicaid coverage when the law was first enacted.”
“Adding unnecessary and very burdensome work reporting requirements to Medicaid was bad public policy to begin with,” said Paul N. Samuels, LAC’s director and president. “This rule makes a harmful policy even worse by flouting clear statutory protections that Congress deliberately included to safeguard people with chronic health conditions, including substance use disorders, whose health and stability depend on uninterrupted access to care. CMS is exceeding its authority by narrowing the law’s medically frail exemption in ways that are not supported by the statute and that directly contradict Congress’s intent to protect vulnerable individuals in need of medical care from losing coverage.”
“The biggest impact of this rule will not be increased employment — it will be increased coverage losses among people who remain fully eligible for Medicaid, but cannot navigate a maze of paperwork and reporting requirements,” said Teresa Miller, LAC’s national director of health initiatives. “When people lose access to care, their health deteriorates, making it harder — not easier — to find and keep a job. The Congressional Budget Office already projected that millions would lose coverage under H.R. 1, and by inserting new layers of red tape and restricting exemptions beyond what the law authorizes, CMS is ensuring that even more people will fall through the cracks.”
Easterseals: Working people will still lose coverage
“Yesterday’s rule from CMS on work requirements will reshape Medicaid for millions of Americans, and we want to be clear-eyed about what comes next,” said Easterseals President/CEO Kendra Davenport in a June 2 announcement. “We have already seen how this kind of policy plays out when it is implemented without strong protections. In Arkansas in 2018, around 18,000 people lost their Medicaid in just a few months — not because they didn’t qualify, but because the paperwork was impossible to navigate. People who were working lost coverage. People with disabilities who were exempt lost coverage. The reporting system itself became the barrier.
“At Easterseals, we help people achieve employment every day. Having healthcare makes employment possible, not the other way around. These work requirements are a penalty for losing a job, missing a piece of mail, or a procedural error — they just cause eligible people to lose the coverage they depend on. That means children and adults with disabilities, older adults, veterans and the family members holding it all together — along with the direct care workers whose jobs exist because Medicaid pays for them.”
National Health Law Program: Administrative barriers will complicate enrollment, renewals
“While the full impact of the rule will depend on both the federal guidance and state implementation decisions, the National Health Law Program (NHeLP) warns that new administrative barriers could make it significantly harder for eligible people to enroll in or maintain the healthcare coverage they rely on,” the nonprofit public interest legal and policy advocacy organization said on June 1.
“Work requirements and other new administrative barriers are bad policy,” said David Machledt, director of Medicaid delivery systems at NHeLP. “They do not make people healthier, help people find jobs, or improve access to care. Their primary effect is to make health coverage harder to get, harder to keep and easier to lose.
“Even if they could be implemented with great care, these policies create new layers of paperwork, reporting obligations and bureaucratic hurdles that prevent access to critical healthcare. NHeLP and our partners will work to ensure these requirements are implemented as fairly as possible and to mitigate the harm they cause, but the reality is that millions of people are now facing new barriers between themselves and the healthcare they need.”
KFF: More restrictive ‘medical frailty’ definition will cause beneficiaries to fall through cracks
“At nearly 400 pages, the rule is quite long and complex and will require time to fully assess its implications,” said Jennifer Tolbert, deputy director, program on Medicaid and the uninsured at KFF (formerly the Kaiser Family Foundation), on June 1. “Given the complexity of the provisions in the rule, states will likely face significant challenges in operationalizing the requirements in the next six months.
“Significantly, the rule adopts a restrictive definition of medical frailty that differs from states’ early expectations,” Tolbert added. “States have been eagerly awaiting clarification on how to define medical frailty. Early indications from CMS offered through informal meetings with states hinted that the federal definition might mirror an existing medical frailty definition used for determining individuals who are exempt from receiving an alternative benefit package, and that states would be given flexibility to go beyond the federal definition.”
That is not what happened, Tolbert said.
“On both counts, the rule adopted a more restrictive approach, first tying medical frailty specifically to the ability to comply with the community engagement requirement (i.e., the ability to work) and prohibiting states from adding categories of individuals to the medical frailty definition,” Tolbert noted. “To operationalize this definition, the rule requires states to develop lists of health conditions, but prohibits them from categorically exempting people with those conditions without considering an individual’s ability to meet the community engagement requirement based on their health.”
Tolbert said the interim rule “does not provide states with a list of diagnoses or criteria for measuring severity or ability to meet new requirements.”
The rule, for example, does not allow states to exempt all people diagnosed with cancer, HIV, Parkinson’s disease, or multiple sclerosis.
