New Guidance on Medicaid May Lead to More Choice for Employers and Employees
New guidelines from the Centers for Medicare & Medicaid Services (CMS) support efforts by certain individual states to test incentives that make participation in work or other community engagement a requirement for continued Medicaid eligibility or coverage.
CMS said it was committing to support state demonstrations to see if these requirements assist beneficiaries in obtaining sustainable employment or other productive community engagement, and if this results in improved health outcomes. Currently, Medicaid covers more than 70 million people, or about 1 in 5 Americans.
According to the CMS guidelines, the state “demonstration programs” must be designed to promote better mental, physical, and emotional health of Medicaid beneficiaries, and to help individuals and families rise out of poverty and attain independence. Some of the activities that eligible adult Medicaid beneficiaries may be required to engage in as work or community engagement include skills/job training, education, job search, caregiving, volunteer service, and substance use disorder treatment.
Kentucky is the first state to receive federal approval for a state demonstration program. Other states that have applied for similar work or community involvement requirements for their Medicaid programs include Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.
The concept of requiring some Medicaid recipients to undertake work has support among Americans. The Kaiser Family Foundation’s monthly health tracking poll last June found that a majority of the public, when asked about proposed changes to the Medicaid program, supported allowing states to impose work requirements on non-disabled adults (70 percent) or drug testing as a condition of enrollment (64 percent). However, fewer supported changes that would cut funding or alter the funding structure.
For employers, this new focus on requiring certain eligible Medicaid recipients to also work may make it easier to help employees find the best healthcare options, even if they are those not offered through company health insurance.
Sometimes there are better healthcare options, based on price, deductibles and coverage, that may be more cost effective provided by a source other than the organization for which the employee works. For instance, some employees will receive a better plan and spend less overall by obtaining an insurance plan under the Affordable Care Act (ACA) healthcare marketplace or other alternative governmental related programs rather than paying into a company-sponsored ACA compliant plan.
In California, there are some companies that are working with third-party vendors to identify employees who may be eligible for lower-cost healthcare options, including Medi-Cal, the state’s version of Medicaid. This is resulting in reduced health care costs for both employers and employees.
While on its face, the new Medicaid requirements asking certain Medicaid recipients to work or become more involved in their communities would appear unrelated to healthcare coverage offered by employers. However, it may actually lead to better healthcare options for low-income working Americans, and reduced costs for both them and their employers.
To learn more about ACA compliance in 2018, click here.
For ACA reporting in 2019, organizations should review this link for important dates and requirements.
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