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Maine’s Proposal To Make Medicaid Recipients Work For Benefits Gets Boost From Feds

The Trump administration announced Thursday that it’s committed to supporting states that want to require Medicaid recipients to work.

Maine is one of 10 states that’s seeking federal permission to do that. Gov. Paul LePage and other Republicans say the policy would help lift people out of poverty. But advocates for Medicaid recipients say implementing a work requirement would not only harm the people Medicaid is intended to help, it would also be illegal.

The announcement came in the form of a guidance letter issued by the Centers for Medicare and Medicaid Services. Jack Comart of Maine Equal Justice Partners says it sets the stage to reverse longstanding Medicaid policy.

“CMS, up until now, has taken the position that work requirements are illegal,” he says.

That’s because the core purpose of Medicaid is to provide health care. And Comart says the majority of people who receive MaineCare, the state version of Medicaid, already work. Instituting a requirement, he says, would be to their detriment.

“What generally happens is people who now are subject to all this red tape end up dropping out of the system because it becomes so complicated. We saw that in the SNAP program, or the food stamp program, in Maine,” he says.

In August, Maine applied for a waiver to its Medicaid program that would require able-bodied individuals to work at least 20 hours a week and pay monthly premiums. The state hasn’t received official approval, but LePage hailed the Trump administration’s announcement that it intends to support work requirements.

In a written statement, LePage said that the requirement will “end isolation, build relationships, improve quality of life and help move our economy forward.”

State Republican Sen. Eric Brakey, a candidate for U.S. Senate this year, sees the same benefits, and says he’s pleased that Maine appears to be on the cusp of getting permission to change Medicaid policy.

“I think it’s going to really help make sure we’re prioritizing our limited welfare resources for Maine’s most vulnerable,” he says.

But Maine Medical Association President Dr. Charles Pattavina says it’s a false economy to think that taking away someone’s insurance will save money.

“One way or another, whether these people have Medicaid or not, you or I will be paying for their health care,” he says.

Because when providers see an increase in uncompensated care, those costs are usually passed on to people with insurance. Darcy Shargo of the Maine Primary Care Association, which represents Maine’s community health centers, says the kind of care that people who lose coverage receive also wouldn’t be as well-coordinated. And that’s potentially a lot of people.

“One of the big health centers in the state, they’re looking at between 18,000 and 26,000 people losing coverage if the work requirement went through,” she says.

Shargo also notes that this drive toward work requirements that could restrict access to insurance comes after Maine voters approved Medicaid expansion this past fall.

Comart says his group will file suit if Maine’s work requirement request is approved.

This story was originally published Jan. 11, 2018 at 10:34 a.m. ET.