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02/22/2018

The Trump Administration's Decision to Require Employment as a Medicaid Coverage Prerequisite: An Interview with Prof. Sara Rosenbaum (February 21st)

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In a letter last March to state Medicaid directors by then DHHS Secretary Tom Price and CMS Administrator Seema Verma telegraph the administration's intent to radically redefine the Medicaid program.  Believing the ACA's expansion of the Medicaid program was, per the March letter, a "clear departure from the core, historical mission of the program,"  administration officials telegraphed they were preparing to reinvent the program by, in part, requiring work or community engagement for abled-body adults as a precondition for Medicaid coverage.  Historically, the Medicaid program was intended to strengthen and increase coverage for the poor.  In a nine-page, January 11 letter to state Medicaid directors, Ms. Verma announced, "a new policy to assist states in their efforts to improve Medicaid enrollee health and well-being through incentivizing work and community engagement."  That there is no evidence that work improves health status, the January 11th letter stated "work . . may improve health outcomes," on January 12th CMS approved a Kentucky waiver to require employment as a prerequisite for Medicaid coverage despite state officials recognizing through the course of the waiver's implementation 15 percent of abled-body Kentuckians would lose coverage.    

During this 20 minute interview, Professor Sara Rosenbaum briefly explains Medicaid 1115 waivers, the administration's intent to, in addition to requiring employment, refashion the Medicaid program to more resemble commercial insurance, what evidence the administration posits to justify the policy change, the details of the Kentucky waiver (the first of likely several, if not many work requirement waivers), the anticipated effects of the Kentucky waiver and the legal bases for litigation already filed to challenge the Kentucky waiver. 

Professor Sara Rosenbaum is the Harold and Jane Hirsh Professor of Health Law and Policy at the Milken Institute School of Public Heath at George Washington University.  She also holds professorships at GWU's Law and Medical Schoold and at the Sara%20Rosenbaum%20Color%20Pic[1]Trachtenberg Schoolf of Public Policy and Public Administration.  Professor Rosenberg worked in the Clinton Administration where she directed and drafted the Health Security Act and designed the Medicaid's Vaccines for Children program.  She currently advises states, foundations and others on health policy and has served as a testifying expert in landmark litigation to enforce children's rights under Medicaid.  She is the lead author of Law and the American Health Care System.  Professor Rosenbaum is the Past Chair of AcademyHealth and a member of the National Academies of Sciences, Engineering, and Medicine.  She also has served on the CDC's Director's Advisory Committee and Advisory Committee on Immunization Practice.  She was the founding Commissioner of the Congress's Medicaid and CHIP Payment and Access Commission (MACPAC) and served as its Chair from January 2016 through April 2017.

Recent related writings by Professor Rosenbaum, i.e., "The Trump Administration Re-Imagines Section 1115 Medicaid Demonstration - and Medicaid" (Health Affairs Blog, 11/9/17) and "Experimenting on The Health of the Poor: Inside Stewart v. Azar (Health Affairs Blog, 2/5/18) are at: https://www.healthaffairs.org/do/10.1377/hblog20171109.297738/full/  and https://www.healthaffairs.org/do/10.1377/hblog20180204.524941/full/.

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