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A University of MI team recently published data in JAMA Internal Medicine from detailed survey of more than 4,000 MI residents enrolled in the state's expanded Medicaid program.

A survey Kaiser conducted a year ago said those who weren't working said it was because of an illness or disability, home or family responsibilities, pursuit of an education, retirement or inability to find a job. Another 12 percent were students, homemakers or retirees. Many Medicaid enrollees may have physical or mental health problems - such as arthritis or asthma - that don't meet the criteria for federal disability programs, but still interfere with their ability to work, Kaiser said.

A full summary of the findings is available here.

Under Kentucky's waiver application, for instance, people on Medicaid would be required to report income changes within 10 days, noted Cara Stewart of the Kentucky Equal Justice Center. Many of these recipients are individuals who are employed but whose jobs do not provide health insurance.

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Despite increased scrutiny and regulation, the rolls have expanded yet Medicaid is not doing its job to care for vulnerable populations, she said.

"Adding a work requirement will only add additional bureaucracy and unnecessary administrative hurdles that will result in fewer people having healthcare". Three other states are contemplating them.

The new policy requires states to assist beneficiaries in meeting work and community requirements in child care assistance, transportation and other support, but said states will not have the authority to use the Medicaid funding to finance these services. It has improved low-income people's financial health, helped states fight the opioid epidemic, and improved access to care.

"Working doesn't make people healthy".

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Medicaid is pretty different from even other government health care programs; its beneficiaries are the poorest people in America, kids, and people with disabilities-a coalition of Americans who often have the most hard health care needs in the country compared with the employer-sponsored private health market. "History from other programs shows people who are working and those who should be exempt lose benefits".

It is not clear how many people will be affected by the new rules. She quoted from a speech President Lyndon Johnson gave a half-century ago, when he said that Medicaid's aim " is not only to relieve the symptoms of poverty but cure it". About 80% of Medicaid enrollees under the age of 65 are already in working families; part of the reason is Obamacare's optional Medicaid expansion for working poor adults who don't have children (prior to the expansion, you often had to be poor and have kids in order to qualify for Medicaid).

The CMS guidance gives states a great deal of flexibility to define their own exceptions to a work requirement, as well as what counts toward work. The vast majority of those who aren't working have an illness or disability, are caring for a family member, or are in school. "Although the details on Maine's waiver request still must be worked out, this decision by CMS is a critical first step". The revised website content signals a new, broader view of these demonstrations in which states can focus on evidence-based approaches that drive better health outcomes, and quality of life improvements, and support upward mobility and self-sufficiency.

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