The Centers for Medicare & Medicaid Services (CMS) has approved (PDF) a waiver to implement work requirements in Wisconsin's Medicaid program, making it the fourth state to enact such an approach.
Under the waiver, beneficiaries in the state's BadgerCare program would have to engage in 80 hours a month of "community engagement activities" including "employment, job training, community service, or enrollment in an allowable work program." The requirements would not apply to people with children or above the age of 50.
The waiver also includes exemptions for those with disabilities or who are medically frail or a primary caregiver. CMS rejected the state's request to drug-test Medicaid beneficiaries.
In a blog post on Wednesday, CMS Administrator Seema Verma acknowledged that "there are people who disagree with this approach" but categorized the so-called community engagement requirement as "a thoughtful and reasonable policy, and one that is rooted in compassion."
"Some believe that our sole purpose is to finance public benefits, even if that means lost opportunity and a life tethered to government dependence," she wrote. "Instead, what’s needed are local solutions crafted by policymakers who are closer to the people they serve and the unique challenges their communities face."
"We will not retreat from this position," she added.
Our welfare reforms are helping people move from government dependence to true independence through the dignity of work. That’s why our reforms include a work requirement for able-bodied people who want to receive public assistance through Medicaid.— Scott Walker (@ScottWalker) October 31, 2018
“With more people working in Wisconsin than ever before, we can’t afford to have anyone on the sidelines: we need everyone in the game,” Wisconsin Gov. Scott Walker said in a statement. “We want to remove barriers to work and make it easier to get a job, while making sure public assistance is available for those who truly need it. Wisconsin is leading the way on welfare reform, and we thank CMS Administrator Seema Verma for her support.”
It's the agency's first approval of work requirements since a D.C. District court struck down the approval of Kentucky's waiver arguing that CMS never adequately considered whether the program would furnish medical assistance to state residents. Another lawsuit has been filed in Arkansas challenging the state's work requirement waiver.
CMS' approval went out of its way to clarify the purpose of the community engagement requirements, even categorizing the term "work requirement" as a "misunderstanding" of the provision.
"Any loss of coverage as the result of noncompliance must be weighed against the benefits Wisconsin hopes to achieve through the demonstration project, including both the improved health and independence of the beneficiaries who comply and the state’s enhanced ability to stretch its Medicaid resources and maintain the fiscal sustainability of the program," the approval stated.