On January 11, the Center for Medicare and Medicaid Services (CMS) issued guidance to state Medicaid directors, allowing them to waive the current Medicaid rules and impose more restrictive eligibility standards. Among the permissible changes to the Medicaid eligibility rules is a requirement that “working age, non-pregnant adult Medicaid beneficiaries who qualify for Medicaid on a basis other than a disability” participate in work or other “community engagement” activity. The CMS letter says that state waiver requests must discuss what “reasonable modifications” to such requirements would be available and how proposals would comply with the Americans with Disabilities Act, Section 504 of the Rehabilitation Act of 1973, and section 1557 of the Affordable Care Act.
If enacted, disability claimants in states that impose such requirements could lose Medicaid eligibility if they are unable to perform required activities while they await a finding of disability. The impact on disability claimants would vary from state to state depending on the specific rules developed by each state’s Medicaid program and authorized by CMS. For example, the eligibility standards requested by Kentucky include a work requirement of up to 80 hours of work per month, payment of Medicaid premiums for certain beneficiaries with household income over $5,100, and the ability to suspend Medicaid eligibility for up to six months for households above the federal poverty line who miss a premium payment. The National Health Law Project, Southern Poverty Law Center, and Kentucky Equal Justice Center have sued CMS and the Department of Health and Human Services in federal district court in the District of Columbia, seeking to prevent Kentucky from enacting its waiver and proposed eligibility standards. If the legal action is unsuccessful, Kentucky’s new rules will go into effect in July.
Other states requesting more restrictive Medicaid eligibility requirements include Arizona, Utah, and Kansas, which have proposed a lifetime cap on the number of years certain groups can receive Medicaid. Indiana, Maine, Wisconsin, and Arkansas also have requested waivers, and other states may be in the process of preparing their waiver requests. Texas has not yet requested additional rules or indicated that they will be seeking to amend Medicaid eligibility requirements.
Going forward, it will be important to keep up with any changes to your state’s Medicaid rules. Issues are certain to arise in relation to the eligibility of claimants who are unable to meet state-imposed work requirements while waiting on a finding of disability. We will be tracking each state’s proposed changes to the Medicaid eligibility rules and will advise our clients accordingly.