Smoking penalties, ER fees, premiums on the poor: How states want to shrink Medicaid

By Jeff Stein

Chris Bondurant of Atlanta, rear left, calls for an expansion to Medicaid outside the state capitol in Atlanta in 2014. (David Goldman/AP)

Indiana hopes to make Medicaid enrollees pay a fee if they smoke cigarettes. Arizona wants to put a five-year limit on how long its poor residents can be enrolled in the program. And Kentucky wants families earning as little as $5,100 to pay Medicaid premiums — and to kick patients out of the program if their payments get 60 days behind.

These proposals are part of a host of changes that mostly conservative states have unsuccessfully sought for years to overhaul Medicaid, a federal insurance program for the poor and disabled.

Now, the Trump administration is giving at least some of these initiatives the green light. On Thursday, health officials issued new guidance to state Medicaid directors, saying the administration would allow states to impose work requirements on certain Medicaid recipients — a first in the program’s 53-year history. Doing so will help Medicaid recipients who are not disabled find employment, Seema Verma, administrator of the Centers for Medicare and Medicaid Services, argued in announcing the changes.

[Trump administration opens door to states imposing Medicaid work requirements]

Ten states have already filed requests for waivers to add work requirements to their Medicaid policies, and the Trump administration approved a proposal Friday from Kentucky to overhaul its Medicaid program, including by imposing new work requirement and premiums.

The states’ proposals vary widely, from small tweaks to changes that would dramatically reduce their program’s size and scope. And many plans go far beyond the new work requirements, pitching provisions that include raising premium payments for Medicaid enrollees, new fees for emergency room visits and requirements for drug testing and treatment.

States administer Medicaid, but it is a …read more

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