Administrator of the Centers for Medicare and Medicaid Services Seema Verma, right, looks on as President Donald Trump speaks during a meeting on women in healthcare in the Roosevelt Room of the White House, Wednesday, March 22, 2017, in Washington.
For instance, Kentucky past year proposed work requirements for able-bodied adults to get Medicaid insurance as well as new fees for all members based on income.
"This new guidance paves the way for states to demonstrate how their ideas will improve the health of Medicaid beneficiaries, as well as potentially improve their economic well-being", said Brian Neale, CMS Deputy Administrator and Director for the Center for Medicaid and CHIP Services. Still, the plan probably will face strong political opposition and even legal challenges over concerns people would lose coverage.
In Massachusetts, MassHealth covers 1.9 million people and has grown into a $16 billion program, accounting for 40 percent of the entire state budget.
Health insurance reforms initiated during Barack Obama's presidency raised the income cap for access to Medicaid, allowing millions of low-income earners to join the Medicaid rolls.
The change would allow states to apply for waivers to require non-disabled working age Medicaid recipients to get a job, volunteer, go to school or enter a work training program.
The Centers for Medicare and Medicaid Services issued guidance making it easier for states to design and propose test programs that implement such requirements. Technically, those waivers would be "demonstration projects".
Lead author Renuka Tipirneni, M.D., M.Sc., a U-M assistant professor of internal medicine, is available to discuss the results and how they might inform the national and state-level discussion about requirements such as those laid out by CMS.
"The present assault on Medicaid is only the most recent salvo of the Trump Administration's 2018 war on social insurance", Brad Woodhouse, chief of the genius ObamaCare amass Protect Our Care, said in an announcement.
Ten states - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin - have submitted waivers that include work or community engagement requirements, according to the agency.
The Louisiana Budget Project, which advocates for low- to moderate-income families, said many nonworking Medicaid recipients have circumstances that make it hard for them to work.
"Medicaid needs to be more flexible so that states can best address the needs of this population".
The Obama administration opposed the demands by the states.
Advocates for low-income people said work has never been a requirement for Medicaid, a program originally intended as a health program for the poor and disabled.
But it's not clear how many people would be affected by the new rules.
A poll past year from the nonpartisan Kaiser Family Foundation found that 70 percent of the public supported allowing states to require Medicaid recipients to work, even as most Americans opposed deep Medicaid cuts sought by congressional Republicans and the Trump administration. Some 60% of non-disabled, working-age adults have jobs, while almost 80% live in families with at least one member in the labor force, according to a Kaiser Family Foundation analysis. Almost 60 percent work either full time or part time, mainly for employers that don't offer health insurance.
CMS said in a news discharge that abilities preparing or training may have the capacity to fulfill the work prerequisites.
The debate about work requirements doesn't break neatly along liberal-conservative lines.
The Trump administration will allow states for the first time to impose work requirements on Medicaid recipients.
The range of community engagement requirements can be quite broad, according to the CMS guidelines sent to states on Thursday.
States will be required to describe strategies that assist individuals in looking for work and what the state will do to connect Medicaid enrollees to employment or community programs.
Solomon, the advocate for low-income people, said the federal government's waiver authority doesn't provide carte blanche to ignore the basic purposes of the program, and promoting work has not been on that list up to now.