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Biden Health Agency Takes Steps to Undo Medicaid Work Rules (1)

Feb. 13, 2021, 12:16 AM; Updated: Feb. 13, 2021, 2:48 AM

The Biden administration on Friday notified several states that it was taking steps to withdraw moves from the Trump administration to preserve requirements that Medicaid beneficiaries work as a condition of coverage.

In letters to Arkansas, Georgia, Ohio, Nebraska, Indiana, Arizona, Wisconsin, South Carolina, and Utah, Centers for Medicare & Medicaid Services acting administrator Elizabeth Richter said the agency is “providing the state notice that CMS is commencing a process of determining whether to withdraw the authorities approved” by the former administration regarding work requirements.

The CMS also sent separate letters to the states rescinding a Jan. 4 letter from former CMS Administrator Seema Verma that said the work requirement waivers would stay in effect even if the new administration tried to disapprove them. Under the Jan. 4 letters from Verma, the agency committed itself to keep Medicaid waivers in effect for nine months after a decision by the new administration to rescind them.

The move marks the first concrete step toward dismantling work requirements, which opponents say drive people off the Medicaid rolls without leading to any increase in employment. The CMS approved work requirement waivers for 12 states—four of which were subsequently blocked by the courts.

The letters to the states are buried on the CMS’s website, and the agency didn’t issue a press release on its move. A CMS spokesperson confirmed the agency’s action and said, “Eligible Americans should be empowered to access and retain the Medicaid coverage to which they are entitled.”

“Uncertainty regarding the current crisis and the pandemic’s aftermath, and the potential impact on economic opportunities (including job skills training and other activities used to satisfy community engagement requirements, i.e., work and other similar activities), access to transportation and to affordable child care have greatly increased the risk that implementation of the community engagement requirement approved in this demonstration will result in unintended coverage loss,” Richter wrote to the states.

Section 1115 of the Social Security Act allows the HHS to waive Medicaid rules to permit states to try out new approaches to serving beneficiaries. Seven states have work requirement waiver proposals pending with the HHS, according to the Kaiser Family Foundation.

President Joe Biden signed an executive order Jan. 28 directing the Department of Health and Human Services to review waivers that “may reduce coverage under or otherwise undermine Medicaid.”

A Supreme Court case reviewing the HHS’s approval of work requirements in Arkansas and New Hampshire is set for oral argument March 29.

(Updates throughout with additional detail, letters, and response from CMS.)

To contact the reporter on this story: Christopher Brown in St. Louis at ChrisBrown@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloombergindustry.com; Alexis Kramer at akramer@bloomberglaw.com

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