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The Trump administration issued guidelines Thursday to help states impose the first-ever work requirements on Medicaid beneficiaries, one of the biggest changes in the program’s 50-year history. That approach contrasts with a move the administration made with less fanfare earlier in the week to extend waivers that allow food-stamp recipients in 33 states to avoid work requirements. The different approaches reflect the complex political forces that surround safety-net programs. (Radnofsky and Armour, 1/11)

Kaiser Health News: Trump Administration Clears Way To Require Work For Some Medicaid Enrollees

The announcement came in a 10-page memo with detailed directions about how states can reshape the federal-state health program for low-income people. The document says who should be excluded from the new work requirements — including children and people being treated for opioid abuse — and offers suggestions as to what counts as “work.” Besides employment, it can include job training, volunteering or caring for a close relative. (Galewitz, 1/11)

Seema Verma, head of the Centers for Medicare and Medicaid Services, said work and community involvement can make a positive difference in people’s lives and in their health. Still, the plan probably will face strong political opposition and even legal challenges over concerns people would lose coverage. (Alonso-Zaldivar, 1/11)

Certain Medicaid populations would be exempt from the rules, including those with disabilities, the elderly, children and pregnant women. Verma also said states would have to make "reasonable modifications" for those battling opioid addiction and other substance use disorders. "This gives us a pathway to start approving waivers," Verma said on a call with reporters on Wednesday. "This is about helping those individuals rise out of poverty." (Abutaleb, 1/11)

Many patient advocates note that a small fraction of the people covered by Medicaid are of working age, non-disabled and currently unemployed. The main impact of the rules will be to subject poor people to stacks of paperwork that will drive some to drop coverage, the critics say. (Levey, 1/11)

To qualify for a waiver, a state must provide a convincing justification that its experiment would “further the objectives” of Medicaid. Unlike the 1996 rewrite of welfare law, which explicitly mentions work as a goal, Medicaid’s law contains no such element, and critics contend rules that could deny people coverage contradict its objectives. To get around this, the 10-page letter argues that working promotes good health. (Goldstein, 1/11)

Ten states -- Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin -- have submitted waivers that include work or community engagement requirements, according to the agency. South Dakota's governor said in his State of the State address Tuesday that he would also look to require certain recipients to work. (Luhby, 1/11)

South Dakota is set to join a growing list of states looking to impose work requirements on Medicaid recipients. The state's Republican Gov. Dennis Daugaard said Tuesday the state will ask the Trump administration for permission to require that work be a condition for eligibility. (Hellmann, 1/10)

A national health advocacy group says it is seriously considering taking legal action against the Trump administration if it approves state proposals that would make key changes to Medicaid programs including requiring tens of thousands of poor Americans to join jobs programs or lose access to health care. Federal health officials are expected to begin announcing decisions on the state Medicaid proposals soon. The plans include a variety of conservative concepts, such as requiring premiums and co-payments, eliminating retroactive coverage and locking people out of coverage for failure to make payments or other issues. (Williams, 1/11)