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Work Requirements in Medicaid Waivers

In a new policy brief, America’s Essential Hospitals examines Centers for Medicare & Medicaid Services (CMS) guidance on work and community engagement requirements for Medicaid eligibility.

In a January 11, 2018, letter to state Medicaid directors, CMS officially announced a significant policy change: guidance on section 1115 demonstration waivers that require beneficiary work and community engagement as a condition of eligibility, coverage, enhanced benefits, or reduced premiums or cost sharing. CMS justified this policy shift in part by emphasizing the need for state flexibility in Medicaid.

The brief outlines recently approved waivers in Kentucky, Indiana, and Arkansas that impose work and community engagement requirements on able-bodied adult Medicaid beneficiaries. The brief also notes states with pending waiver requests that include such requirements.

Policy Brief — Work Requirements in Medicaid Waivers

KEY FINDINGS:

  • CMS issued guidance outlining parameters for states to condition Medicaid eligibility on work and community engagement activities through section 1115 Medicaid demonstration waivers.
  • Kentucky, Indiana, and Arkansas recently received waiver approvals to impose work and community engagement requirements on able-bodied adult Medicaid beneficiaries.
  • Several states are awaiting CMS approval for similar demonstrations, and other states are in the early  stages of pursuing this policy option.
  • Consumer groups and policy organizations are concerned about CMS’ authority to make this policy change and about the effect of work and community engagement requirements on beneficiaries and coverage.

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