KELLY MCEVERS, HOST:
The Trump administration is encouraging states to require people on Medicaid to work for their health benefits. New guidelines issued today say states can make so-called able-bodied adults either work, volunteer or get job training to qualify for the program. It's up to states to define that. The administration says working and participating in society leads to better health, but opponents say it's the other way around. People need to be healthy to hold down a job.
NPR health policy correspondent Alison Kodjak is with us now to talk about this. And Alison, just explain. What exactly do these guidelines say?
ALISON KODJAK, BYLINE: Well, so they came in the form of a letter from Seema Verma, who's the head of the Center for Medicare and Medicaid Services, to the state Medicare, Medicaid directors. And it basically says that the CMS will invite proposals for states to impose work requirements on Medicaid recipients.
They give some examples of what those would be - like you said, work, volunteer work, job training or perhaps caring for an elderly parent or even - they even suggested drug treatment programs could qualify. And then they talked a lot about who the rules can affect and who could and could not be exempted.
MCEVERS: I mean, my understanding is that the majority of able-bodied people on Medicaid already work. So who is likely to be affected by these new rules?
KODJAK: Yeah, and that's true. Right now about 60 percent of people on Medicaid who aren't deemed disabled have jobs. And the rules say anyone who's medically frail or has an acute illness is exempt. And people caring for minor children could be exempted.
And then there's this whole population of people who are able-bodied in the context of Medicaid, meaning they get Medicaid benefits for a reason other than disability, but they might be considered disabled by the Americans With Disabilities Act. And the guidelines say they have to take that into account as well. So I've read a couple of example - analyses that say basically only about 3 to 10 percent of the people on Medicaid could even be affected by this rule.
MCEVERS: States have to apply for a waiver if they want to impose these work rules. Are they likely to do it, and how soon could we see actual work requirements go into effect?
KODJAK: Yeah. So actually, 10 states already have applied for these waivers.
KODJAK: They include Michigan, Kentucky, Arizona, Indiana - you know, several more because earlier this year, Seema Verma told state Medicaid administrators that she was open to this idea and that these rules would be coming. And we could see some results pretty soon 'cause there are rumors swirling that by tomorrow, Kentucky's application could possibly be approved.
MCEVERS: What is in that application?
KODJAK: It follows along with what we've been discussing. Adult on Medicaid would have to work, volunteer, get training or even take a GED class for 20 hours a week in order to keep their benefits. And they do have a list of exempt rules that include people with acute illnesses. So it follows along with the guidelines that were sent out today.
MCEVERS: The Centers for Medicare and Medicaid Services in allowing these rules is saying that working leads to better health. Is there evidence to back that up?
KODJAK: Well, CMS is asserting that, and they have cited several studies in their guidelines. But those studies really just show a correlation. They show that people with jobs and higher incomes are generally healthier than people who don't have them. And that makes sense of course. But there's a bit of a chicken and egg issue. Some people are - there's a question of whether people are unhealthy because they're not working, or are they unemployed because their poor health prevents them from working? And opponents are worried that that's the problem. If they can't become healthy, they won't be able to get a job.
MCEVERS: NPR's health policy correspondent Alison Kodjak, thank you so much.
KODJAK: Thank you, Kelly.
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