CMS to Allow States to Impose Work Requirements for Medicaid Recipients

WHA reiterates concerns to DHS on WI’s proposed policies

January 12, 2018

On January 11, the Centers for Medicare and Medicaid Services (CMS) announced a new policy that would allow states to make participation in work or other community engagement a requirement for Medicaid recipients. The announcement immediately drew national attention, with those opposed indicating it will likely undergo legal challenges in the days to come. 

The new policy by CMS represents a fundamental change to the Medicaid program. In its letter to state Medicaid directors, CMS indicated that requiring work or participation in community engagement activities meets the objectives of the Medicaid program because work helps to promote physical, mental and emotional health. CMS says the requirements would be allowed only for Medicaid recipients who are not elderly, pregnant or disabled. States would be required to seek federal approval through a waiver process, commonly known as the 1115 waivers. 

Wisconsin is one of ten states that have submitted—but not yet received approval for—requests to CMS seeking approval for several Medicaid policy changes, including work requirements. This was done in June 2017 as a proposed amendment to the existing waiver related to adults without dependent children or “childless adults.” In addition to the work requirements, Wisconsin’s proposal also included several other new policies such as the imposition of premiums and copayments for Medicaid recipients. (See
May 19, 2017 Valued Voice article.

While CMS’ new guidance supports states interests in implementing work requirements, Wisconsin may need to make changes to its proposed policy to be compliant with CMS’ guidance. For example, CMS’ guidance clarifies that states should consider community service and other activities that could count toward the work requirement. CMS also says states should exempt individuals with acute medical conditions. Both of these are issues WHA raised in its comment letters to DHS and CMS in June 2017. 

CMS also outlines the requirements for monitoring and evaluation of the work requirements to ensure they meet outcomes, including “whether those requirements assist beneficiaries in obtaining sustainable employment or other productive community engagement and whether sustained employment or other productive community engagement leads to improved health outcomes.”

In Wisconsin, although the waiver amendment has yet to be approved, the underlying childless adult waiver is set to expire in December 2018. DHS is planning to submit a request for a waiver extension.  As such, on January 5, 2018, WHA took the opportunity to again advance its concerns regarding policies such as premiums and copayments, and to encourage DHS to seek enhanced federal funding for its expansion of Medicaid to the childless adult population. WHA’s comments can be found here

This story originally appeared in the January 12, 2018 edition of WHA Newsletter