The Trump administration issued guidance to states early Thursday that will allow them to compel people to work or prepare for jobs in order to receive Medicaid for the first time in the half-century history of this pillar of the nation’s social safety net.
The letter to state Medicaid directors opens the door for states to cut off Medicaid benefits to Americans unless they have a job, are in school, are a caregiver or participate in other approved forms of “community engagement” — an idea that some states had broached over the past several years but that the Obama administration had consistently rebuffed.
The new policy comes as 10 states are already lined up, waiting for federal permission to impose work requirements on able-bodied adults in the program. Three other states are contemplating them. Health officials could approve the first waiver — probably for Kentucky — as soon as Friday, according to two people with knowledge of the process.
The guidance represents a fundamental and much-disputed recalibration of the compact between the government and poor Americans for whom Medicaid coverage provides a crucial pathway to health care.
The idea of conditioning government benefits on “work activities” was cemented into welfare more than two decades ago, when a system of unlimited cash assistance was replaced by the Temporary Assistance for Needy Families with its work requirements and time limits. The link between government help and work later was extended to anti-hunger efforts through the Supplemental Nutrition Assistance Program, as food stamps are now called.
But most health policy experts, including a few noted conservatives, have regarded the government insurance enabling millions of people to afford medical care as a right that should not hinge on individuals’ compliance with other rules.
a close up of text on a white background© Leah Binkovitz/
The Trump administration has signaled from the outset that it wanted to set a more conservative tone for Medicaid, a 1960s-era program that was part of Lyndon Johnson’s anti-poverty Great Society. On the day in March when she was sworn in as administrator of the Centers for Medicare and Medicaid Services, Seema Verma dispatched a letter to governors encouraging “innovations that build on the human dignity that comes with training, employment and independence.”
While some conservatives pressed her agency to quickly issue guidelines, lawyers within the Health and Human Services and Justice departments jockeyed for time to construct a legal justification that they hope can withstand court challenges.
The legal issue is that states must obtain federal permission to depart from Medicaid’s usual rules, using a process known as “1115 waivers” for the section of the law under which the program exists. 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 and repeatedly asserts that the change fits within the program’s objectives. The guidance cites research that it says demonstrates people who work tend to have higher incomes associated with longer life spans, while those who are unemployed are more prone to depression, “poorer general health,” and even death.
“[A] growing body of evidence suggests that targeting certain health determinants, including productive work and community engagement, may improve health outcomes” the letter says. “While high-quality health care is important for an individual’s health and well-being, there are many other determinants of health.”
The critics are prepared to pounce on that rationale.
“This is going to go to court the minute the first approval comes out,” predicted Matt Salo, executive director of the National Association of State Medicaid Directors, whose members reflect a spectrum of views about requiring work. The association
Once CMS gives one state permission, “we would be looking very, very closely to the legal options,” said Leonardo Cuello, health policy director at the National Health Law Program. “It’s not a good idea, and it’s illegal.”
Cuello said the argument that work promotes health is “totally contorted . . . It’s a little like saying that rain causes clouds. It’s more that people [with Medicaid] get care, which helps them be healthy and makes them able to work.”
The most recent federal figures show that Medicaid enrolls more than 68 million low-income Americans, including children, pregnant women, people with disabilities and the elderly. Under the Affordable Care Act, the program has expanded in more than 30 states to cover residents with somewhat higher incomes.
In states that now choose to link Medicaid to work, the requirement would apply only to able-bodied adults as defined by each state.
Sixty percent of Medicaid’s non-elderly adults already work, according to a recent analysis of census data by the Kaiser Family Foundation. Of those without a job, more than a third are ill or disabled, 30 percent are caring for young children, and 15 percent are in school, the analysis shows.
The CMS guidance gives states a great deal of flexibility to define their own exceptions to a work requirement, as well as what counts toward work. “Each state is different,” the letter says, and such activities “include, but are not limited to, community service, caregiving, education, job training, and substance use disorder treatment.”
The guidance specifies only that pregnant women and “medically frail” people be exempt — though frailty is not defined — and that people with opioid addiction be either exempted or allowed to count time in drug treatment toward work activities. It also suggests that states take into account the local availability of jobs in creating requirements. People receiving TANF cash assistance or SNAP food benefits who meet those programs’ work requirements will be considered in compliance with Medicaid’s rules.
Whilestates should help people on Medicaid meet their requirements — for instance, by helping them find child care, transportation or job-training — they may not use any Medicaid funds to do so, the letter says.
In the states that adopt such requirements, critics say, the effect will spread far beyond the healthy adults who do not already comply. Those who have a job, are in school or care for young children will need to document to their state’s Medicaid agency that they are in compliance — or risk losing their benefits.
Under Kentucky’s waiver application, for instance, people on Medicaid would be required to report income changes within 10 days, noted Cara Stewart of the Kentucky Equal Justice Center. For low-wage workers, such as waitresses with fluctuating wages, “it boggles my mind,” Stewart said.
Before she became the CMS administrator, Verma was a health-care consultant who specialized in helping states redesign their Medicaid programs. She was an architect of Kentucky’s waiver application once a Democratic governor who had eagerly embraced the ACA was succeeded by Matt Bevin, a Republican who campaigned on a pledge to reverse the program expansion there.
Verma also had a major role in designing an unorthodox approach to Medicaid in Indiana, which had asked the Obama administration to approve a work requirement. In the end, that state included in its Medicaid expansion only an encouragement of voluntary efforts by beneficiaries to train for work or find jobs. Indiana rewrote its waiver request last summer, this time asking for federal permission to compel work activities.
Verma has recused herself from ruling on those two states’ requests but has imported the ideas behind them into the new federal policy.
Qatari Labor Minister Leads Fruitful Labor Conference With Key Recommendations
The 111th session of the International Labor Conference successfully concluded under the leadership of Ali bin Sameegh Al-Marri, the Minister of Labor from Qatar. The conference received international praise from representatives of governments, employers, and workers within the International Labor Organization for its achievements in promoting social justice and creating decent job opportunities.
Ali Al-Marri was unanimously elected as the President of the International Labor Conference during its 111th session. This marks the first time an Arab minister has held this prestigious position since the organization’s establishment in 1919. Qatar’s election as the conference’s chair recognizes the country’s significant contributions to labor and development, leading to a safe and healthy work environment.
During his closing speech at the conference, Chairman Ali Al-Marri emphasized that Qatar’s presidency reaffirmed its commitment to supporting collaborative efforts and multilateral cooperation in achieving sustainable development goals. He expressed gratitude to the member states for entrusting Qatar with the conference’s leadership.
Al-Marri highlighted the conference as a crucial platform for governments and social partners to engage in dialogue and joint action concerning contemporary labor issues. Despite facing some challenges, the 111th session successfully fulfilled its ambitious agenda thanks to the collective efforts of all participants.
The conference and its committees produced important outcomes that will contribute to the organization’s efforts, as well as member states, in improving the world of work. The Committee on Apprenticeships, in particular, showcased the power of social dialogue and achieved significant results through vibrant negotiations, cooperation, and the exchange of experiences.
— وكالة الأنباء القطرية (@QatarNewsAgency) June 16, 2023
Recognizing the importance of quality apprenticeships in addressing the evolving world of work, Al-Marri stressed their role in promoting social justice, decent living conditions, and poverty eradication. The conference’s discussions emphasized the significance of protecting workers and their essential contribution to gender equality, social justice, and the reduction of inequalities. Furthermore, such protection leads to sustainable enterprises, productivity gains, and economic development.
Al-Marri commended the International Labor Organization’s guidelines for a just transition toward environmentally sustainable economies and societies for all, considering them as a fundamental reference for policy-making and actionable steps.
The conference’s approval of the organization’s program and budget for the 2024/2025 period was met with praise. Al-Marri lauded the spirit of cooperation and flexibility that facilitated a consensual solution, demonstrating the ILO’s commitment to constructive dialogue.
Al-Marri also commended the World of Work Summit, themed “Social Justice for All,” which took place alongside the conference. The summit saw the participation of 16 heads of state, government officials, ministers, representatives from international organizations, and social partners from various regions. It discussed various issues related to social justice, including the proposal to form a global coalition for social justice by the organization’s Director-General.
During the closing session, representatives acknowledged the challenges posed by recent global crises and emphasized the significance of the equal apprenticeship recommendation in advancing the just transition of economies.
The conference’s final session featured speeches from Gilbert Hongbo, the Director-General of the International Labor Organization, Henrik Montai, Vice-President of the Conference representing the Employers’ Team, Mohamed Zuhour, Vice-President of the Conference representing the Workers’ Team, and Corina Ajdar, Vice-President of the Conference representing the governments. They expressed their gratitude and appreciation to Minister of Labor Ali bin Smaikh Al-Marri for his effective leadership and successful attainment of the conference’s objectives.
Strategic Twinning of Rabat And Madrid: A Defense Against Mediterranean Tension
Rabat – The writer-journalist, Abdelhamid Jmahri believes that the wish today of Morocco and Spain, after the clarification of the foundations of their cooperation, is to establish a geostrategic twinning that goes beyond the limits of close cooperation and privileged partnership, thus blocking the way to maneuvers aimed at exacerbating tensions in the Mediterranean region.
Al Itihad Al Ichtiraki”
In an editorial to appear in the Saturday edition of the Arabic-language daily “Al Itihad Al Ichtiraki”, he notes that this ambition is clearly displayed through the will of HM King Mohammed VI in His call to inaugurate “a new unprecedented stage ” and also that of King Felipe VI of Spain calling for weaving partnership relations for the 21st century.
He maintains that the High Level Meeting (RHN) held last Thursday in Rabat is the bearer of strategic partnerships specific to countries concerned with a perfect understanding of their common interests and also sharing the same conception of the interactions of international action, at the present time. as in the future.
While emphasizing that the two Kingdoms have set a living example on the priority nature of the conciliatory diplomatic approach and its supremacy in the settlement of disputes, he observes that the agreements signed during this High Level Meeting relate to key sectors targeted , in support of a common understanding of priorities.
This article is originally published on msn.com
Spain-Morocco Reconnection: Post-Crisis Efforts
After a deep diplomatic crisis, Spain and Morocco cemented their reconciliation on Thursday in Rabat, despite criticism in Madrid over too many concessions from Prime Minister Pedro Sanchez.
Mr. Sanchez, accompanied by a dozen ministers, co-chaired a “high-level meeting” (RHN) with his counterpart Aziz Akhannouch, the first since 2015.
“Today we are consolidating the new stage in relations between Morocco and Spain that we have opened,” he said, praising “the enormous unexplored potential of this relationship”.
Before his arrival in Rabat on Wednesday, the Socialist Prime Minister spoke by telephone with King Mohammad VI who invited him to return “very soon” to Morocco for an official visit “in order to reinforce this positive dynamic”, according to the royal cabinet.
Mr. Sanchez ended last March a year of diplomatic estrangement with Morocco by agreeing to support Moroccan positions on Western Sahara.
The crisis erupted in April 2021 after the hospitalization in Spain – under a false identity according to Rabat – of the leader of the Sahrawi separatists of the Polisario Front, Brahim Ghali, sworn enemy of Morocco.
The Rabat-Madrid honeymoon comes as France – another historical partner of Rabat – is pilloried by Moroccan politicians and media who accuse it of having “orchestrated” a European Parliament resolution worrying about freedom of the press in Morocco and allegations of corruption of MEPs in Brussels.
But this idyll is not to everyone’s taste in Spain. The radical left formation Podemos, member of the government coalition, did not wish to be on the trip to Rabat, citing its opposition to Mr. Sanchez’s “unilateral” turn on Western Sahara. A turnaround applauded in Rabat.
The fact that Mr. Sanchez was not received by Mohammad VI is seen as a snub in Spain by the right-wing opposition and the press. The Popular Party, the main opposition force, deplored Thursday, through the voice of its general coordinator Elias Bendodo, that “Spain has given an image of weakness”.
“The absence of Mohammad VI spoils the summit”, wrote the daily El Païs (center left) while the newspaper El Mundo (conservative) headlined: “Mohammad VI shows his position of strength with regard to Spain by posing a rabbit to Sanchez”.
New Economic Partnership
Pedro Sanchez said he hoped for the development of “new investment projects accompanying the extraordinary process of development and modernization of Morocco”. “Morocco and Spain wish to establish a new economic partnership at the service of development”, underlined for his part Mr. Akhannouch.
Twenty agreements were signed on Thursday to facilitate Spanish investment in Morocco – Spain is the third largest foreign investor there – in the fields of renewable energies, water desalination, rail transport, tourism , education and culture. To this end, a new financial protocol has been approved which will double – to 800 million euros – aid from the Spanish government for investment projects in Morocco.
Also in the pipeline is an agreement to “completely normalize the passage of people and goods” through sea and land borders. The opening of land crossings concern the Spanish enclaves of Melilla and Ceuta, in northern Morocco.
Without forgetting the files of illegal immigration and the fight against terrorism. Madrid highlighted the drop of more than 25% in illegal immigration in 2022 thanks to its police cooperation with Rabat, with 31,219 migrants entering Spain illegally in 2022.
This cooperation, welcomed by Rabat, was however tarnished by the death of at least 23 Sudanese migrants who had tried last June to enter the enclave of Melilla via the Moroccan border town of Nador.
The Minister of the Interior, Fernando Grande-Marlaska, was also to plead with his Moroccan counterpart, Abdelouafi Laftit, to reactivate the channels for the expulsion of irregular migrants and return to levels prior to the Covid-19 pandemic. , according to a source from the Spanish ministry.
Finally, Rabat is considered a key partner in the fight against terrorism. An important subject for Madrid after an attack at the end of January attributed to a young Moroccan in an irregular situation against two churches in Algeciras (South) in which a sexton was killed.
This article is originally published on lorientlejour.com
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