It continually refused, arguing that the policy goes against the goals of the program, which are to give more people access to health insurance.
Nine other states have similar waiver requests sitting before Trump's Department of Health and Human Services, and more approvals are expected in the coming weeks. Trump's decision can be reversed by a future administration, however, so we just have to survive the next three years, if that.
The approval comes just one day after the Trump administration announced new guidance meant to encourage states to apply for such waivers, something that has never before happened in the 50-year history of the Medicaid program.
Verma stressed that the administration is providing an option for states to require work, not making it mandatory across the country.
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"CMS has not previously approved a community engagement requirement as a condition of eligibility", the agency's approval letter said. "Those days are over". Several other states are considering such work requirements.
At times, Bevin has framed the waiver as an attempt to improve the health of a state that consistently shows up near the bottom of national rankings. "We are committed to helping more people get into the workforce, as it is critical not only for individuals but also for our economy as a whole".
Exempting pregnant women, disabled people and the elderly.
Another Kaiser study found that most working-age adults on Medicaid are already employed.
A bipartisan commission appointed to study the issue over the summer, led by Majority Leader Jeb Bradley, R-Wolfeboro, recommended that the program be continued but left numerous details to lawmakers - including how the state will pay for its 10 percent share of the expansion in 2020 and beyond.
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That approach contrasts with a move the administration made with less fanfare earlier in the week to extend waivers that allow food-stamp recipients in 33 states to avoid work requirements. However, they will not be allowed to use federal Medicaid funding to finance these services. In the past, federal officials said work was not among those objectives.
The bottom line: Though they may make for good political headlines, Medicaid work requirements are wasteful and ineffective.
"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", Brian Neale, CMS deputy administrator, said in a press release. In his 2012 majority opinion in NFIB v. Sebelius, U.S. Supreme Court Justice John Roberts affirmed this view, writing, "Under the Affordable Care Act, Medicaid is transformed into a program to meet the health care needs of the entire nonelderly population with income below 133 percent of the poverty level". Those 80 hours can be from a job, volunteer work or job training. But most of that will accrue to the federal government which pays for 90 percent of the costs for the expanded Medicaid population. Right now about 60 percent of people on Medicaid who aren't deemed disabled have jobs.
For example, she said, time spent in medical treatment for opioid addiction might be counted toward compliance with a state's work requirement. And it basically says that the CMS will invite proposals for states to impose work requirements on Medicaid recipients. That's never happened before in the program's 52-year history, but a bunch of red states - at least 10 at last count - want to deny health care to adults who don't have a job or at least prove their disability prevents them from holding one. And the rules say anyone who's medically frail or has an acute illness is exempt.
Despite such exemptions, Democrats called the new policy inhumane and mean-spirited, echoing criticism of work requirements in a welfare law adopted in 1996.
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"I would assure Mr Wilson and all of our patients that we are monitoring the situation very closely and working hard to minimise delays".