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New Medicaid Requirements Signals Trump Crackdown On Public Assistance Programs


Another potentially significant move by the president last week happened without any fanfare, an executive order he signed quietly to create work requirements for people receiving federal benefits such as food stamps and Medicaid. Now several states, including Kentucky, already require people who Medicaid to prove that they work. But so far, the courts have blocked those efforts. We wanted to hear more about this, so we called Diane Rowland of the Kaiser Family Foundation. She's done extensive research into Medicaid and other health insurance programs.

DIANE ROWLAND: The executive order really says to each of the departments, including the Department of Health and Human Services, to go to any program that provides assistance to individuals who are low income and really enforce a work requirement in order for them to retain their benefits in that program. And it's the first time that such a order would go to programs like Medicaid.

MARTIN: You know, I think the argument in favor of these requirements are twofold. One is that people who are not receiving public benefits who, say, get their health insurance through a job generally lose that coverage when they lose that job. And I think the argument for some is that that kind of brings the public benefit program in alignment with the way it works in the private sector. And the second argument is that it improves your life to work. What do you say about that?

ROWLAND: When you're working and getting coverage through your employer and you lose your job, you can then go to the marketplace and get coverage through the Affordable Care Act's marketplaces. So you're not locked out of coverage. What we're talking about in Medicaid is saying that someone who doesn't meet these requirements then can be locked out and not be able to get medical coverage for a certain number of months or maybe even up to a year. And they do say that there'll be exceptions, but the president's directive wants to narrow those exceptions. So really, some of the purpose of this is to get people off the rolls. And we know that for the people already working on Medicaid, the reason they need Medicaid is their job doesn't come with health insurance that's either available or affordable.

MARTIN: Are these new regulations responding to the expansion of Medicaid that occurred in some states under the Affordable Care Act? Are they related in some way?

ROWLAND: One of the criticisms by opponents of the Affordable Care Act was that Medicaid was being used to expand coverage beyond those who deserved to get Medicaid assistance. They coined the phrase able-bodied adults, which has now sort of stuck as these are people who should be out working and aren't. But the reality is that most of them are working. And it's really become sort of a stalking horse for repealing the Affordable Care's expansion of Medicaid to more adults.

MARTIN: Some analysts are saying that this is really more of a public relations initiative, rather than something that will actually have force in policy because it actually is incompatible with the mandates of the program and therefore cannot actually happen. Do you have an opinion about that?

ROWLAND: You know, I think that there will be challenges to rather this should happen or not. But I think the most important thing about the president's executive order is it signals a real change in direction of how public assistance to low-income families in America is viewed. And so I think we're at a point where the administration is signaling that it is going to look across the board at all forms of assistance to low-income families and clamp down on that in part to achieve budget savings and in part to be able to honor some of what the president views as his commitments during the campaign.

MARTIN: That is Diane Rowland, executive vice president of the Kaiser Family Foundation. Transcript provided by NPR, Copyright NPR.