What Medicaid work requirements could mean for Pennsylvania

Jan. 12--The Trump administration is opening the door for states to impose work requirements on individuals enrolled in Medicaid, the government health insurance for the poor.

The move is unlikely to affect Pennsylvania in the short-term: Democratic Gov. Tom Wolf vetoed a work-search requirement passed last year by the Republican-controlled state Legislature. But several candidates seeking to replace him in this year's gubernatorial election say they support the idea.

What is the Trump administration allowing states to do?

In a letter to state Medicaid directors, the White House is signaling a willingness to approve state requests to require people seeking health coverage through the Medicaid program to have a job or participate in other approved forms of "community engagement."

It describes "community engagement" as activities such as skills training, education, searching for a job or caregiving.

Ten states already had sought federal permission to impose work requirements before Thursday's announcement, according to Seema Verma, the administrator of the federal Centers for Medicare and Medicaid Services.

Why is the Trump administration talking about a work requirement?

Federal Medicaid officials compared a work requirement to similar conditions in other programs like food stamps, now known as the Supplemental Nutrition Assistance Program, and the welfare program known as Temporary Assistance for Needy Families.

They also argued in the letter to states that work and community engagement may improve health outcomes. Opponents have said such requirements create hurdles and red tape for those seeking health care.

Who would be affected?

Almost two-thirds of Medicaid recipients nationally are children, elderly or disabled, and will be exempt from the new requirements. In Pennsylvania, more than half -- 52 percent -- of enrollees are children younger than 20, and seniors 65 and older. (Those figures also include some disabled enrollees).

There were nearly 2.9 million Pennsylvanians enrolled in Medicaid in November, with 144,971 of those in the Lehigh Valley.

Wolf's administration has highlighted how Medicaid has helped those suffering from opioid addiction or other substance abuse disorders to obtain treatment and medication. The federal memo instructed states to craft "reasonable modifications" allowing Medicaid enrollees who need addiction treatment to continue accessing services.

That could include counting time spent in medical treatment toward the work requirement, or exempting them from it entirely.

Has Pennsylvania considered a work requirement?

Wolf vetoed a budget-related bill last year that would have required the administration to include a work-search requirement in the Medicaid program. He reiterated his opposition Thursday, saying it would impose "arbitrary limits around employment on an already extremely vulnerable population."

Republican legislators and other supporters argued the change would have saved money in an expensive program.

A work requirement also was part of a proposal from former Republican Gov. Tom Corbett in 2013 as he crafted an alternative Medicaid expansion plan.

House Republicans in Harrisburg are still seeking a work requirement for Medicaid, and included the concept in a package of welfare reform proposals announced last week.

How much does Pennsylvania spend on Medicaid?

Medicaid is one of the largest expenses from the state's General Fund, with $8.4 billion of nearly $32 billion in state spending paying for the program. The federal government provides a little more than half of the program's overall cost, and state taxpayers the rest, according to data from the Kaiser Family Foundation.

While children and nondisabled adults make up most of the enrollees, most of the program's spending is on the elderly and people with disabilities.

What do the Republicans seeking to replace Wolf as governor say about the proposal?

Wolf is running for re-election this year, meaning that state voters will determine who will be in the governor's office if the Legislature approves another Medicaid work requirement bill next year.

Trump's popularity is already an issue in the race, and now his Medicaid work-rule decision could become a campaign issue as Republicans criticize Wolf's record.

Republican candidate Scott Wagner, a York County state senator and businessman, supports the work requirement guidelines outlined, said his campaign spokesman Andrew Romeo. Laura Ellsworth, a Pittsburgh-area lawyer and also a GOP contender, also supports Trump's plan.

So does candidate Paul Mango, a western Pennsylvania businessman, who said in a statement that Obamacare's Medicaid expansion -- which allowed more nondisabled adults to access the program's health coverage -- "is stretching the safety net for some of our most fragile populations."

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