Trump administration offers states six-month delay on Medicaid work requirements

WASHINGTON — The Trump administration announced Friday that states can take an additional six months to implement a provision in Republicans’ “big, beautiful” law that requires most people enrolled in Medicaid work, participate in community service, or attend an education program at least 80 hours a month.

The Centers for Medicare & Medicaid Services wrote in a statement that it’s established an “optional hold harmless period” to give state governments more time to update their systems and improve the processes they have in place.

“States have made real progress, and they’ve been clear with us about what it takes to get this right for beneficiaries—at scale and for the long term,” Dan Brillman, director of the Center for Medicaid and CHIP Services, wrote in the statement.

“If the state can use data to show that someone is working or qualifies for an exclusion, that person should not have to track down paperwork to prove it. And when someone needs support, they should know exactly what to do, when to do it, and where to go,” Brillman wrote. “That’s how we build a Medicaid program that works better for people, connects them to work, education, and training opportunities, and supports paths to prosperity.”

It’s unclear if Missouri will take additional time to implement the changes.

“The Missouri Department of Social Services is evaluating new guidance from the Centers for Medicare & Medicaid Services offering states an optional hold harmless period for community engagement implementation,” said Baylee Watts, the department’s media director, in a statement to The Independent Friday afternoon.

The state has poured millions of dollars into preparations to implement the federal law, including hiring contractors to process backlogged Medicaid renewals and an overhaul of the online dashboard participants use to apply for Medicaid and SNAP. The current state budget includes $35 million in state general revenue — out of a total $295 million — to comply with federal policy changes.

Once the requirements are enforced, the state will have to verify that most Missourians ages 19-64 covered through Medicaid expansion worked, attended school or volunteered 80 hours a month to enroll or maintain coverage. The state will also be required to check enrollees’ eligibility every six months instead of annually.

There were 330,490 Medicaid enrollees in Missouri’s adult expansion population as of Nov. 6, according to department data.

Some experts and advocates have urged the department to take opportunities offered by federal officials to give reprieve to Missourians who might struggle to meet the work requirements.

Missouri is one of three states declining optional short-term hardship exceptions for people who were recently hospitalized, traveled to receive medical treatment or lived in an area with a federally declared disaster or high unemployment. The department has said it plans to accommodate most people who would qualify for a temporary reprieve due to an acute medical event through the mandatory “medical frailty” and caregiver exemptions.

Democrats in Congress raised concerns as recently as this week that states hadn’t had enough time to prepare for the new 80-hours-a-month requirement.

House Energy and Commerce Committee ranking member Frank Pallone Jr., of New Jersey, and Senate Finance Committee ranking member Ron Wyden, of Oregon, wrote in a letter dated Wednesday that administration officials use their “discretion to give states additional time to implement work reporting requirements and protect eligible beneficiaries from losing coverage.”

The provision in the law requires Medicaid enrollees between the ages of 19 and 65 to work, participate in community service, or attend an education program for at least 80 hours a month.

The law detailed several exceptions, including for pregnant people, parents of dependent children, people who have complex medical conditions, tribal community members, those in the foster care system, people who were in foster care who are below the age of 26 and individuals released from incarceration in the last 90 days, among others.

Missouri plans to use a federal option to accept self-attestations of “medical frailty” during the first year of implementation. 

The medical frailty exemption in federal law applies to people who are blind or disabled, have substance use disorders, disabling mental disorders, serious or complex medical conditions, or physical, intellectual or developmental disabilities that significantly impair daily activities.

Jeremy Bowman, deputy director of Missouri’s Family Support Division, said during a public webinar Oct. 28 that the department plans to use data it gathers during the self-attestation period to develop a list of diagnostic codes that will help automate medical frailty determinations when self-attestation is no longer allowed.

Bowman said Missourians will have 35 days to submit additional information once the department requests it.

Watts, of Missouri’s social services department, previously told The Independent that this data will help the department verify exemptions on an ex parte basis — without asking individuals for additional information — when possible.