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Analysis

Wisconsin Wins Federal Approval for Medicaid Work Requirements

By Steven Porter  
   October 31, 2018

The state is the fifth to secure approval for such a program, but a federal judge blocked Kentucky's waiver last summer, so Wisconsin is the fourth with an active waiver.

The federal government formally approved Wisconsin's plan Wednesday to impose work requirements on certain Medicaid recipients, signaling that the Trump administration is not backing down from the controversial policy position.

Wisconsin is the fifth state to secure such an approval; since a federal judge blocked the approval of Kentucky's waiver last summer, however, only four have active approvals, including Indiana, Arkansas, and New Hampshire.

Some of the same groups that won their challenge to Kentucky's waiver have filed a similar action to challenge the program in Arkansas.

"I recognize that there are people who disagree with this approach," Centers for Medicare & Medicaid Services Administrator Seema Verma wrote in a blog post announcing the approval of Wisconsin's waiver. "Some believe that our sole purpose is to finance public benefits, even if that means lost opportunity and a life tethered to government dependence."

"Instead," Verma added, "what's needed are local solutions crafted by policy makers who are closer to the people they serve and the unique challenges their communities face."

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Related: Arkansas Medicaid Work Requirement Faces Legal Challenge

Related: Despite U.S. Court's Ruling, Medicaid Work Requirements Advance in Other States

"We will not retreat from this position," Verma wrote.

Who's Affected?
 

Each state tailors their Medicaid waivers to meet local needs and policy priorities, so the details of the work requirements—which the Trump administration calls "community engagement requirements"—vary from one state to another. Wisconsin's work requirements will apply to adults younger than 50 who don't have children and who don't qualify for an exemption.

What Must They Do?
 

Wisconsin's waiver calls for non-exempt Medicaid beneficiaries to take part in employment, job training, volunteer work, or enrollment in a qualified work program for at least 80 hours per month. They have four years to bring themselves into compliance; if they fail to do so, they will be deemed ineligible for Medicaid for six months before the four-year timeline starts over.

Health Risk Assessment
 

The waiver also includes a provision for a new Health Risk Assessment program. Adults subject to the work requirements must also undergo an assessment of their health risks when they apply for Medicaid coverage.

"This will allow the state to collect important information that can be used to help individuals identify their own health risks, reward beneficiaries for proactively avoiding certain health risks, and equip health plans with information to better address health needs in a more timely and complete manner," Verma wrote in her blog post.

More specifically, beneficiaries could have their premiums reduced by up to 50% if they avoid health risk behaviors, including excessive alcohol consumption, failure to diet or exercise, illicit drug use, tobacco use, or failure to wear a seatbelt, according to CMS documents.

Political Timing
 

This decision comes as Wisconsin Gov. Scott Walker, a Republican, seeks another term in next week's election.

Citing an unnamed source, Politico's Dan Diamond reported Wednesday morning that the Trump administration has been ready to approve Wisconsin's waiver for weeks but that Walker has been uneasy with the timing of the waiver approval. The governor's administration disputed that account.

While critics contend Medicaid work requirements are designed to kick people off the program, the Trump administration and its allies have argued that such requirements help people rise out of poverty.

"This is a thoughtful and reasonable policy, and one that is rooted in compassion," Verma wrote in her blog post. "That's because true compassion is giving people the tools necessary to achieve self-sufficiency and to experience the dignity of a job, of contributing to their own care, and gaining a foothold on the path to independence. It is not compassionate to lower our expectations such that we are content to leave Americans with inherent worth on the sidelines of life."

Steven Porter is editor at HealthLeaders.

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