STAT News recently reported on the newly issued federal Medicaid work requirements and the concerns they raise for patients and healthcare providers. The interim final rule, released by the Centers for Medicare & Medicaid Services, introduces new directives for implementing these requirements. Of particular concern are the additional hurdles for individuals with high medical needs who have historically qualified for Medicaid under the “medically frail” category.
Under the new standard, individuals must prove not only that they have a serious medical condition, but that the condition directly impairs their ability to work. Advocates point out that this two-step verification process creates significant administrative burdens for states, clinicians, and patients. Previously, many states had planned to automatically exempt individuals based on specific, pre-defined complex health diagnoses.
In turn, these stricter verification processes and increased administrative hurdles could result in significant coverage losses for millions of Medicaid beneficiaries. ACH CEO Amanda Pears Kelly highlighted how these changes could affect health center patients and others navigating complex health challenges:
“Patients managing serious chronic conditions, mental and behavioral health challenges, substance use disorders, cancer, and other complex health needs should not be forced to prove their inability to work in order to maintain access to the care and treatment they rely on.”