Kentucky Medicaid Waiver Approval Harms Hard-Working People

Washington, DC, January 12, 2018—The Center for Law and Social Policy (CLASP) strongly condemns the Centers for Medicare and Medicaid Services (CMS) decision today approving Kentucky’s Medicaid waiver. This action by CMS imposes new barriers to health care for tens of thousands of Kentuckians. Contrary to CMS’s assertion, this waiver does not promote improved health access or any other objective of Medicaid.

For the first time, CMS has approved a state waiver allowing for work requirements in Medicaid. The decision today by the Trump Administration goes against all precedent. Previous administrations have rightfully denied such requests as inconsistent with Medicaid objectives because work requirements act as an obstacle to coverage.

The majority of people insured through Medicaid are working or are in a household where someone works. Kentucky’s policy proposal expands government by adding unnecessary bureaucracy and red tape. We know from experience with other public support programs that eligible people who are already working or deemed exempt from working are likely to lose coverage simply because of having to complete additional paperwork and overcome enrollment hurdles—not because they are ineligible for the program.

Studies have shown that access to Medicaid makes it easier for people to look for work and obtain employment. A so-called “work requirement” does not support work but instead puts a critical support for work at risk. CLASP Senior Policy Analyst Suzanne Wikle commented “When people are not healthy or able to get needed medications they are less likely to be able to work. If proponents of work requirements are serious about helping people find work, they would invest in skill training and workforce development programs rather than make it harder for people to access health care.”

Furthermore, while CMS stated in its January 11 letter to state Medicaid directors that states must describe strategies for linking Medicaid enrollees to “additional resources for job training or other employment services, child care assistance, transportation, or other work supports” the letter also clearly states that Medicaid dollars cannot be used to provide these services. This places a new burden on Kentucky’s workforce development and child care systems without providing any new federal dollars to meet the demand.

Kentucky's waiver is troubling for both the work requirement and several other barriers to enrollment. Enrollees will now face a six-month “lock-out” period if they do not report certain changes in their circumstances. This means that enrollees must have in-depth knowledge about Medicaid policy. Additionally, Kentucky will eliminate retroactive eligibility and non-emergency transportation services for certain Medicaid populations, as well as begin charging premiums.

Collectively, the new policies in the Kentucky waiver force Medicaid and Kentucky significantly backward. Once a shining example of how the Affordable Care Act (ACA) can benefit a state, Kentucky is quickly demonstrating how best to sabotage hard-working people’s access to health insurance.

If CMS is serious about the demonstration and evaluation component of this waiver, the agency should not approve any other waiver requests by states to impose work requirements until Kentucky’s effort has been implemented and the findings of an independent evaluation have been reviewed.

CLASP reiterates our disappointment in today’s decision by CMS and stands ready with our partners to fight back against new policies and procedures that limit access to Medicaid by everyday Americans.