CMS pressed to give more time for comment on Medicaid-work changes

The National Health Law Program (NHeLP) is pressing the Centers for Medicare and Medicaid Services (CMS) to give the public more time to comment on state proposals to impose work requirements in the Medicaid program.

NHeLP sent a letter to the agency just hours after CMS unveiled guidance letting states apply for waivers requiring certain Medicaid enrollees work or participate in community engagement in order to get health coverage. The guidance marked a major policy shift in the joint federal-state health program for low-income and disabled Americans.

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The state and federal comment periods have closed for at least seven states that have already asked CMS to allow them to institute work requirements, according to NHeLP. Though the public has already commented on those specific waivers, NHeLP argues that “as advocates, we had no opportunity to respond to the various, specific issues raised in CMS’s letter.”

“As a result, these state-specific comments fall far short of the type of public notice and comment that typically attaches to such a significant about face,” Jane Perkins, NHeLP’s legal director, writes. The letter asks CMS to reopen or extend those comment periods.

CMS Administrator Seema Verma touted the guidance, tweeting that “We owe beneficiaries more than a #Medicaid card; we owe them the opportunity and resources to connect with job skills, training and employment so they can rise out of poverty.”

She praised the move as one of freeing up flexibility for states, which Republicans say is sorely needed in the health-care system.

But Democrats and many advocates are pushing back on the guidance, arguing people will lose coverage if they don’t meet the requirements or the requirements will lead some not to apply because the process may become too cumbersome. They say the move doesn’t meet the objectives of the Medicaid waiver program, and Democratic groups are expected to file lawsuits over Medicaid work requirements.

“The Trump administration is on wobbly legal ground in trying to limit Medicaid enrollment by imposing onerous work requirements,” Perkins said in a statement. “As our letter explains, the administration is making an about face in its efforts to overturn established [Department of Health and Human Services] policy against work requirements without public comment.”

On a press call, Verma defended the legality of imposing work requirements, saying the waiver language in the law gives the administration “broad authority.”