A poll a year ago from the nonpartisan Kaiser Family Foundation found that 70 percent of the public supported allowing states to require Medicaid recipients to work, even as most Americans opposed deep Medicaid cuts sought by congressional Republicans and the Trump administration.
"One of the things that states have told us time and time again is that they want more flexibility to engage their working-age, able-bodied citizens on Medicaid", Verma told a conference of state Medicaid directors in November. "What she is in fact doing is promoting the hard bigotry of animus against poor people - the hard and shameful bigotry of health care denial based on wealth", Weissman concluded. Almost 60 percent work either full time or part time, mainly for employers that don't offer health insurance.
In addition, people who are disabled under the Americans with Disabilities Act but have Medicaid benefits for another reason could be exempted, or the state would be required to make "reasonable modifications" such as a reduced hourly requirement to ensure that the requirements don't disproportionately hurt people with disabilities.
Lambeth said he has been puzzled by the Trump administration's slow approach to the state Medicaid waiver request.
The Obama administration stretched the guidelines for Medicaid coverage to allow millions of working adults to qualify for the program.
Verma said the agency wants to give states as much latitude as possible to try out their own ideas.
"The new [state programs] will penalize individuals by having them lose health coverage, rather than incentivize them, as a voluntary program with adequately funded supportive services necessary to overcome barriers, would", she said.
"There are a lot of different ideas, and a lot of ways to go about this", Verma said.
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Before she became the CMS administrator, Verma was a health-care consultant who specialized in helping states redesign their Medicaid programs.
-Allowing people under treatment for substance abuse to have their care counted as "community engagement" for purposes of meeting a requirement.
Brian Neale, director of the federal Medicaid office, believes the new program will be greatly helpful for those involved.
"This is just the latest in Trump and Republicans' relentless assault on Medicaid and the broader set of federal programs people rely on". Many Republicans opposed the enlargement of Medicaid eligibility authorized under Obamacare.
The conditions would exclude individuals eligible for Medicaid due to disability, elderly beneficiaries, children and pregnant women.
Sixty percent of Medicaid's non-elderly adults already work, according to a recent analysis of census data by the Kaiser Family Foundation.
Children account for more than two-fifths of those enrolled, with seniors or persons with disabilities accounting for an additional one-fifth, according to the Center on Budget and Policy Priorities. Thursday the Trump Administration announced it's encouraging states to add these requirements for able-bodied adults. Verma and other Republicans said implementing work and community engagement requirements could help improve health outcomes by connecting people with jobs and training.
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.
Verma also had a major role in designing an unorthodox approach to Medicaid in IN, which had asked the Obama administration to approve a work requirement.