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This week, Seema Verma announced that the administration would not approve several requests by states to place lifetime limits on Medicaid benefits. How about that? The CMS doesn't do much to protect benefits these days, but this is a pretty good one. Work requirements are still happening though, so there's that.


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There's some big announcements about Medicaid this week, and they're not all terrible. I know! This is Healthcare Triage News.


A number of states have been working on trying to get lifetime limits imposed on Medicaid, and if you follow me on Twitter, you know this caused me to nearly lose my mind a couple weeks ago. That's because Medicaid is an insurance system of last resort. It covers the poorest among us. It covers those who are often too disabled or sick to work. It's not cake! It reimburses your physicians when you get care. You can't sit at home and live high on the hog on Medicaid. Moreover, taking away someone's insurance doesn't incentivize them to not be sick anymore. My ulcerative colitis isn't hanging around just because I've got insurance. 

Anyway, this week, Seema Verma and the Centers for Medicare and Medicaid Services announced that they will not approve Kansas's request to approve lifetime limits on Medicaid. They wanted to cap people's eligibility after three years. Three years for a lifetime!

Approving this would have been a tectonic shift in entitlement programs for everyone, and it could have had huge effects. That it didn't get approved is likely disappointing for states like Utah and Arizona, which were considering similar changes to their programs.

Of course, Kansas can still institute work requirements, which we've discussed before. You may have also seen some news this week on states getting those up and running.

In Michigan, for instance, policymakers are trying to get a plan together that requires work-eligible people to work or at least prove they searched for work for at least 29 hours a week to get Medicaid. But, they want to exempt people who live in counties with high unemployment rates (say 8.5% or higher). A number of people have pointed out that predominantly white rural counties will be exempt from the work requirements, but urban communities with more African Americans will not.

Governor Rick Snyder has not been very supportive of the plan, which means it may not pass. But these things, as with everything in health care, are complicated. We have to make sure what we're doing doesn't have negative consequences.

Other states have gotten work requirements approved, and we'll have to keep watching how they're implemented. Kansas is looking for one, too. Because they didn't put in a Medicaid expansion, they're stuck in this weird world where very poor people need to get work to get Medicaid, but if they earn just a little money than they're too rich for Medicaid. I have no idea how they think this is going to work.

But, for the moment, Medicaid advocated can breath a sigh of relief that the Trump administration seems to have found the line they won't cross in cutting people off from their Medicaid.


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