How will the Trump Administration’s decision to allow states to impose work requirements on Medicaid recipients affect recipients who are recovering from addiction? The answer isn’t clear yet, but some recipients could certainly be affected.
For recipients, there are two main questions; (1) Do you live in a state that will request a work requirement waiver, and (2) will that waiver include addiction?
So far, only Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin have requested waivers. South Carolina will soon join the list. However, now that the Administration has indicated that it is likely to approve waivers, more states may follow suit.
The Administration has made it clear that it won’t approve all waivers; it will accept only those that are “likely to promote the objectives of Medicaid.” This involves a case-by-case review of a large number of factors.
In its letter announcing its shift in policy, the Centers for Medicare & Medicaid Services specifically addressed coverage for people affected by addiction. Here’s what it said:
“CMS also recognizes that many states currently face an epidemic of opioid addiction, which has been declared a national public health emergency by the Secretary. States will therefore be required to take certain steps to ensure that eligible individuals with opioid addiction and other substance use disorders (who may not be defined as disabled for Medicaid purposes but may be protected by disability laws) have access to appropriate Medicaid coverage and treatment services. States must make reasonable modifications for these individuals, consistent with states’ obligations under civil rights laws described above, and specifically identify such modifications in their demonstration applications. Such modifications may include counting time spent in medical treatment towards an individual’s work/community engagement requirements, or exempting individuals participating in intensive medical treatment (e.g. inpatient treatment or intensive outpatient treatment) for substance use disorder from the work/community engagements requirements. CMS will also consider other reasonable modifications that states may design and propose in furtherance of their obligations under disability laws. Finally, states should identify, in their demonstrations, other strategies to support such individuals in meeting the requirements, and in obtaining access to treatment when they are ready.”
This means that states may have a hard time getting a work requirement waiver that applies to recovering addicts.
Needless to say, addiction makes it hard to get a job. Not only does recovery often require great effort, but many employers require drug tests and have policies against hiring people with criminal histories.
In addition, the new CMS policy states that the work requirement should be able to be fulfilled through other activities, including searching for work, participating in a job training program, committing time to volunteering, or being a full-time caregiver.