Amber Christ: Hello everybody, and welcome to as we speak’s webinar, Implementing New Medicaid Work Necessities: Methods to Mitigate Hurt in Your State. My title is Amber Christ, I take advantage of she/her pronouns, and I’m the managing director of Justice In Getting older’s Well being Advocacy. I am joined as we speak by my colleagues, Natalie Kean and Gelila Selassie, administrators on our well being staff who’ve been main our advocacy on work necessities. If we go to the subsequent slide, earlier than we dive into content material, just some logistics: All members are going to be on mute. When you have a query concerning the materials being offered or a technical concern, please use the query operate. We are going to go away time on the finish for Q&A. Should you expertise difficulties accessing the webinar at any time, please e-mail trainings@justiceinaging.org.
The supplies we are going to talk about as we speak can be found on Justice In Getting older’s web site and our useful resource library. A recording of the webinar may even be posted within the useful resource library and made accessible on our Vimeo web page. The hyperlinks to the assets have additionally been shared within the chat field. If you want to allow closed captioning, hit the CC operate in your Zoom platform.
Just a bit bit about Justice In Getting older for these of you who could be new to us: we’re a nationwide authorized group targeted on eradicating senior poverty by rising entry to inexpensive healthcare and rising financial safety for older adults with restricted assets. And we deal with older adults who’ve been marginalized and excluded from justice, together with older adults of shade, ladies, LGBTQ+ older adults, older adults with disabilities, older immigrants, and people whose main language is just not English. To hold out our mission, we at Justice In Getting older are dedicated to making sure everybody has entry to what they want as they age, with out discrimination.
Our advocacy is rooted in making certain that these experiencing the best boundaries to financial safety, healthcare, and housing can train their rights and absolutely entry the companies and applications they want. And if you want to join our community in case you’re not already on it, on the subsequent slide, you are able to do so on our web site by navigating to the signup hyperlink, or by emailing us at data@justiceinaging.org.
If we transfer to the subsequent slide, we’ll get into the agenda. In July, Congress handed and the president signed into legislation the Finances Reconciliation Act of 2025, also referred to as H.R.1. And that features the biggest cuts to Medicaid in historical past. The legislation additionally mandates that states add work necessities to their Medicaid applications, and that’s the focus of this webinar. Including work necessities is a elementary change to Medicaid applications, and we’re all nonetheless on this figuring it out section of that change.
The Facilities for Medicare and Medicaid Companies continues to be issuing steerage to states on implement the legislation, and states are nonetheless determining their insurance policies to operationalize the brand new work necessities of their applications. So as a result of we’re nonetheless on this figuring it out section, we can’t but advise shoppers on navigate work necessities. The foundations simply aren’t there but. As an alternative, our objective now and the aim of this webinar is to give you instruments to form these guidelines and insurance policies in your states, and a option to scale back the quantity of people that lose protection.
And geez, there’s loads to determine and to be taught earlier than these necessities take impact. In actual fact, we obtained over 400 questions from you all earlier than the webinar, a lot of which we hope to deal with over the subsequent hour. So as we speak, Natalie and Gelila are going to offer an summary of labor necessities, what we learn about exclusions and exemptions, implementation challenges and advocacy methods, and instruments and assets presently accessible. After which we’ll finish with some Q&A. So I’ll kick it over now to Gelila to start out with an summary of labor necessities.
Gelila Selassie: Thanks a lot, Natalie, and thanks all for becoming a member of us as we speak. Simply reemphasizing Amber’s… Or excuse me. Thanks, Amber. Reemphasizing Amber’s fantastic factors that we’re very a lot specializing in what’s on this statute associated to Medicaid work necessities. I want we had much more detailed info from you, however we do not have that from the Feds but. So keep tuned to our upcoming assets that can hopefully get that info out to you. However for now, we’re wanting on the statute and H.R.1 and no matter specifics we do learn about mitigate the harms in your shoppers. Subsequent slide.
In order a fast overview, final July Congress handed H.R.1, which is also referred to as the One Large Lovely Invoice Act, and that applied Medicaid work necessities. And simply as some extent of clarification: On this statute, these work necessities are often known as neighborhood engagement necessities, however they’re successfully work necessities. So we’ll be referring to it as that, however it’s the identical factor. These work necessities are distinct from SNAP, the meals stamps program, or TANF. These applications do have work necessities, and there could be some extent of overlap however these are positively completely different. So we’ll actually simply deal with the necessities below the Medicaid program, and never making an attempt to conflate the 2 in a method that is going to be extra complicated.
Advocates are very, and rightly, involved about work necessities as a result of it is at all times been a failure every time it has been applied in different states. Most Medicaid recipients, most individuals who obtain Medicaid are working. And people who do not are disabled, caregiving, or at school, that means that there is going to be lots of protection losses primarily based on what we all know the financial savings are going to be from these Medicaid work necessities. Lots of people who shouldn’t be topic to work necessities or who’re working and simply cannot get across the administrative paperwork will lose protection.
We have seen that in a pair cases the place work necessities had been applied in Arkansas and in Georgia of their applications, the place there was very gradual processing. There was web site issues in reporting hours. There was an enormous, burdensome, restrictive course of in making an attempt to show that persons are truly exempt. So primarily based on what we have discovered from that and what’s within the legislation, we’ll hopefully attempt to have a look at reduce a few of these harms. After which it is actually essential to notice that these work necessities have to be applied by January 1st, 2027, however states do have the discretion to implement it sooner. Subsequent slide.
So the legislation requires most adults who’re ages 19 to 64 enrolled in Medicaid Enlargement or Enlargement-like protection to interact in not less than 80 hours a month of qualifying work actions. And people qualifying work actions may be paid employment, it may be education or training, volunteer work, or job coaching. Once more, we’ve lots of unknowns concerning the particulars about a few of these. We all know that these hours may be mixed. So you would do 50 hours of labor, 20 hours of volunteering, 10 hours of training so as to meet these 80 hours. However we’re ready for extra steerage on how that is truly going to be operationalized.
After which one actually distinctive high quality about these work necessities is that there’s actually a lockout provision within the statute. Which means that if somebody who’s topic to work necessities is just not in compliance with it, then additionally they can’t obtain ACA Market subsidies. That is actually problematic as a result of lots of people, in the event that they’re now not eligible for Medicaid, might not less than get the Market subsidies in the event that they meet that, in the event that they’re above 100% of the federal poverty degree. And now there’s this provision right here that is going to throw a wrench into that potential avenue for well being entry. Subsequent slide.
And so states do have some discretion with some extent of those reporting necessities. H.R.1 requires enrollees to adjust to work necessities, to indicate compliance with the work necessities not less than one month previous to enrollment or their redeterminations. Nevertheless, the statute additionally provides states discretion to require somebody to indicate as much as three months’ compliance previous to enrollment. So if somebody had been to be making use of for Medicaid in December, they have to, at a minimal, present that they are working in November.
On the similar time, this particular person, the state might determine that that individual has to truly present greater than that. In the event that they’re making use of for protection in December, they might say, “Properly, we want you to indicate us that you’ve got been working since September.” After which one other space of discretion is with respect to how usually these work necessities are reported. At a minimal the statute requires it to be performed at redetermination or renewal time. This was on an annual foundation, however H.R.1 modified that for the Medicaid Enlargement inhabitants, who will now must submit renewals or redeterminations each six months.
So at a minimal, folks have to indicate that they are complying with the work necessities not less than each six months. However states can select to require extra frequent reporting intervals. They might require it to be each different month, each three months, and even month-to-month, which might be essentially the most burdensome. Subsequent slide.
And so there was some steerage that was issued by CMS final month. For essentially the most half it wasn’t terribly useful. It form of simply reiterated what was in H.R.1, however it did present this useful chart that provides you a visible illustration of what the state should do with respect to how they’re implementing work necessities. So states should present beneficiary outreach not less than three months earlier than the person has to indicate compliance with the work necessities. So below choice one, if this state is implementing January First, 2027 and an individual is making use of in January, then they have to present that they met these neighborhood engagement necessities in December. That implies that the state has to start out reaching out to beneficiaries, offering notices, offering training by September.
Possibility two is that if that state, once more, individual’s making use of January, however that state says you need to present us you had been in compliance with the work necessities two months upfront earlier than your utility date. Properly, then the state has to start out issuing beneficiary notices and training by August. After which similar thought if the state says, “You realize what? Truly, show to us that you’ve got met the work necessities not less than three months earlier than your utility date.” Then the state must concern outreach by July. So all that is to say that, not less than by September of this yr, all states needs to be participating in beneficiary outreach. Ideally it might be method sooner, even when a state is not implementing till January, as a result of we all know how sophisticated and convoluted this course of may be. Subsequent slide.
And so now we discuss… We talked about meet the work necessities. We’ll look into the completely different exclusions and exemptions which can be accessible. Subsequent slide.
It is actually essential to notice that not all Medicaid enrollees are topic to work necessities. H.R.1 particularly defines relevant people who’re topic to work necessities as people who’re enrolled in ACA Medicaid Enlargement or states which have applications which can be Enlargement-like, that are actually simply Georgia and Wisconsin. And only a level of clarification: Medicaid Enlargement is the protection pathway that grew to become accessible below the Inexpensive Care Act that covers adults ages 19 to 64 with incomes as much as 138% of the federal poverty degree. So it is a group that doesn’t have to indicate incapacity or that they belong to another Medicaid class. In the event that they’re between 19 to 64 with revenue under 138%, that’s the Enlargement inhabitants.
40 states and the District of Columbia have adopted Medicaid growth, after which Georgia and Wisconsin did one thing a bit bit in another way, the place they’ve Medicaid choices which can be similar to Medicaid Enlargement, however they went about it in a barely completely different method they usually have a bit bit extra restrictions on it. So in that method, that’s the expansion-like applications, Georgia and Wisconsin, as a result of it is nonetheless protecting these relevant people. So these 41 states plus Georgia and Wisconsin are those which can be topic to the H.R.1 work necessities for his or her Medicaid Enlargement enrollees ages 19 to 64.
And so one other factor that’s fairly sophisticated, as a result of why not? About H.R.1, is a special terminology that is used to explain who is just not topic to the work necessities. So we all know relevant people who’re the Enlargement inhabitants are topic to it, however there are people who find themselves not, and the primary are the categorically-excluded. These are people who find themselves not enrolled in Medicaid Enlargement or the Georgia and Wisconsin Enlargement-like applications. They’re in a very completely different Medicaid class. Then there are individuals who have particular person exemptions, and these are relevant people within the Enlargement inhabitants, however they’re exempted from these work necessities as a consequence of particular person circumstances, which we’ll get into. After which the final class are for the short-term hardship exception. And this might apply to everybody topic to work necessities, however it’s a state choice. So a state could or could not take this up. And we’ll dive into this in a bit bit extra element. Subsequent slide.
After which simply, once more, to reiterate: This is not precisely the language that is used within the statute, however we discover it a lot simpler to divvy it out this fashion. The primary class are the specific exclusions. So the state should exclude the next group from work necessities as a result of they don’t seem to be relevant people. They don’t seem to be in that Enlargement program. These are folks below age 19 or age 65-plus, people who find themselves enrolled in or entitled to Medicare, together with the duly eligible and those that are receiving a Medicare financial savings program, anybody receiving Medicaid below the age, blind, or disabled program, which additionally contains folks on SSI, as a result of they obtain SSI Medicaid. After which for the medically-needy share of cross enrollees. After which anybody receiving Medicaid for being pregnant or postpartum protection. These people who’re a part of these Medicaid classes shouldn’t must show or require any form of verification for exemption. They shouldn’t be anyplace within the work necessities world. So we do not need states to attempt to loop them in and begin requiring them to supply sure paperwork or sure sorts of verification as a result of they’re fully excluded. They don’t seem to be relevant. Subsequent slide.
After which, inside the world of the relevant people are those that have certified for these particular person exemptions. And it is actually essential to notice that we’re ready once more for steerage on precisely how these exemptions will likely be verified. However once more, as we have seen previously with the few states which have applied work necessities for the restricted interval that they’d, there are lots of people who’re unable to work, and so they need to meet these exemptions.
That is notably true for older adults, age 50 to 64, who’ve boundaries to work associated to power sickness or incapacity. They might be retiring early or they might have caregiving duties. So there’s numerous particular person exemptions, and we’ll listing all of them however we’ll first deal with exemptions for a incapacity. So in case you can transfer to the subsequent slide.
And that is an exemption that’s accessible to somebody deemed medically frail. That’s the language within the statute. We don’t like that however, once more, as a result of that is the language, we’ll discuss with that. And in H.R.1, somebody is medically frail in the event that they belong to any considered one of these six classes: In the event that they’re decided blind or disabled below the Social Safety Administration’s guidelines, if they’ve a substance use dysfunction, if they’ve a disabling psychological dysfunction, a bodily, mental, or developmental disabilities impacting considered one of their ADLs, or exercise of every day residing, or if they’ve a critical or advanced medical situation.
And there are two large factors to boost right here. First is that, notice that the Social Safety definition of disabled, which is the lack to work due to a incapacity, that is only one method of assembly the medically frail exemption. Congress clearly added these extra classes to say that states shouldn’t solely defer to the blind or disabled below SSA guidelines kind of definition. It is what lots of Medicaid companies are conversant in as a result of there are Medicaid incapacity pathways which can be associated to those social safety guidelines. And so we need to guarantee that states are broadening that exemption to incorporate all of those classes that Congress particularly included.
After which one other main level is that this language on the finish of great or advanced. And that is not critical and sophisticated. This might be a extremely nice catchall for individuals who do not meet one of many different classes for the medically frail exemption as a result of if it was critical and sophisticated, that might positively be much more narrower. So once more, we’re ready on additional steerage of this, however that is one thing you must hold at the back of your minds. Subsequent slide.
There may be additionally an exemption [inaudible 00:18:43]. H.R.1 offers the exemptions for folks, guardians, caretaker, relative, or household caregivers of a dependent little one age 13 or below, or a disabled particular person, which incorporates older adults, which I will get into. H.R.1 explicitly references the RAISE Household Caregiver Act for the definition of a caregiver, and the RAISE Act’s language, the precise definition of a caregiver is an grownup member of the family or different particular person who has a big relationship with and who offers a broad vary of help to a person with a power or different well being situation, incapacity, or useful limitation.
So once more, right here the RAISE Act could be very broad and would not simply apply to caregivers for folks with disabilities, but additionally that language of somebody with a power or different well being situation, incapacity, useful limitation. That’s a lot broader than incapacity. And it is actually essential for the older grownup inhabitants as a result of many older adults won’t think about themselves as disabled, however they could discuss with themselves as having a useful limitation, of getting a well being situation, and that they’ve any individual of their lives who’s serving to them handle every part due to their situation or their limitations.
So once more, it is actually, actually essential that states apply this broader RAISE Act definition that Congress explicitly included in H.R.1, moderately than solely limiting this Caregiver Exemption to folks with disabilities. Subsequent slide.
After which there are numerous extra exemptions past simply the medically frail and the caregivers that we’re not going to spend an excessive amount of time on, however very a lot value noting. Foster care youth or former foster care youth, American Indians, Alaska-natives, Californian Indians, and those that are eligible for Indian well being companies, disabled vets with whole incapacity rankings, people who’re already assembly the work necessities below SNAP or TANF qualify for an exemption right here within the Medicaid world. So once more, the principles for Medicaid work requirement are positively completely different from these different public advantages applications, however not less than if somebody is assembly the SNAP or TANF necessities, then they need to qualify for the exemption within the Medicaid world, even when they’re completely different applications.
After which members “In a qualifying substance use dysfunction remedy program,” or people who’re incarcerated or not too long ago incarcerated, which is outlined as a person who’s an inmate of a public establishment or was so inside the prior three months. Subsequent slide.
After which our final large class of people who find themselves not topic to the work necessities are those that are eligible for these short-term hardship exceptions. Once more, that is on the state’s discretion to implement. And in the event that they do, it applies to people who’ve the next extenuating circumstances: These might be people receiving care in hospitals, nurse amenities, psychiatric amenities, or a different intensive care setting, anybody residing in a federally-declared catastrophe space. In the event that they’re residing in counties with a unemployment price increased than 8% or a couple of and a half instances the nationwide unemployment price, in the event that they’re required to journey outdoors the neighborhood for medical care, both for themselves or their dependents to deal with a critical or advanced situation for an prolonged time frame. And once more, none of those have been notably outlined by CMS but, however we’ll be staying tuned for extra info there. After which subsequent slide.
I’ve stated this earlier than however it’s actually, actually value emphasizing once more simply because H.R.1 could be very ambiguous and never superb at differentiating the teams that aren’t topic to work necessities: People receiving Medicaid below one of many excluded teams, in order that they’re in a Medicaid class outdoors of the Enlargement group, shouldn’t ever, ever have to use for or confirm that they are excluded from work necessities. The state ought to by no means be together with them of their techniques when evaluating for work necessities. And that is completely different from the exempted people who belong to the Medicaid group topic to work necessities, the Enlargement inhabitants, however their particular person circumstances qualify them for a selected exemption.
So simply to match: Should you had a 61-year-old on SSI who’s receiving Medicaid due to SSI, they need to by no means be evaluated for work necessities or exemptions. They need to be fully out of that system. But when that 61-year-old has a pending utility for SSI as a consequence of incapacity and has not but been permitted, after which they’re receiving Medicaid by way of Medicaid Enlargement, then they have to present that they’re medically frail to be exempted from the work necessities. And within the latter case they do not even want a pending utility with SSI. They might be disabled and, for a wide range of causes, not be making use of for SSI or SSDI, however they’re medically frail, they’re enrolled in Medicaid Enlargement, and they also must have some form of verification to indicate that they meet that medically frail exemption. And so with that, I’ll flip it over to Natalie to debate a bit bit extra about how the implementation will work.
Natalie Kean: Nice. Thanks, Gelila. Good to be with everybody. Gelila reviewed lots of what we all know the legislation says, however there are nonetheless lots of questions and uncertainty about how will probably be applied. I’ll go over our suggestions for mitigate burden and hurt on older adults, and caregivers particularly, after which present some examples of the issues we have seen and heard from advocates about how states are designing their insurance policies and applications, and recommend some advocacy methods to deal with these issues. First are rules. These are primarily based on how the legislation is written and making an attempt to maximise the protections accessible.
First, we would like states to routinely and completely exclude non-Enlargement populations from work requirement consideration. That is the specific exclusion Gelila mentioned, equivalent to folks age 65 and older, folks with Medicare, folks with SSI. They need to by no means have to use for an exemption from work necessities. The state needs to be routinely excluding them. Our second precept is that individuals who can work have to be eligible to obtain exemptions. The legislation doesn’t make work and exemptions mutually unique. Many individuals equivalent to caregivers and other people with disabilities or critical well being situations do work. They’re employed. However they need to additionally be capable of get an exemption that they are eligible for to guard them from protection loss.
Our third precept is that medically frail standards can’t be restricted to strict Social Safety incapacity standards. That is what Gelila mentioned. Most individuals eligible for Medicaid on the idea of incapacity are already excluded, so the medically frail standards is clearly supposed and should transcend these strict standards. Precept 4: Explicitly embrace caregivers for older adults within the Household Caregiver Exemption. The statute contains these caregivers however doesn’t title older adults. So we’re advocating that states ought to title caregivers of older adults of their insurance policies and supplies.
Precept 5: Settle for self-declarations to confirm eligibility for exemptions, notably for caregivers and individuals who qualify as medically frail. There aren’t any information sources to determine many, many caregivers and to seize the breadth of people that would possibly qualify as a caregiver or for the medically frail exemption. So it is actually essential that states settle for self-declarations for exemptions.
Quantity six: Use ex parte and different instruments to attenuate administrative burden and procedural terminations. And I will go into extra element on what ex parte is, however we would like states to be making exemptions as automated as doable. There aren’t at all times information sources to do that, however the place there are, they need to be used for exemptions in addition to compliance with work.
Quantity seven: Present superior outreach, training, and accessible help, together with details about due course of and attraction rights. That is actually about preparation and making certain the method can be accessible. So how states are going about speaking to folks concerning the work necessities, how states are designing their functions, after which following the protections in legislation for Medicaid enrollees on this course of as properly.
So shifting on to among the points we have seen on the bottom already, states do have some choices in how they implement the legislation, as Gelila went over. And what they select could make it simpler or tougher for folks to adjust to these new necessities. Among the methods states could make it tougher are utilizing a three-month moderately than a one-month lookback interval for brand spanking new candidates and requiring month-to-month compliance for enrollees. A state is also strict and slender eligibility by rising reporting intervals to month-to-month as an alternative of each six months, not take up the momentary hardship exceptions, and implement the work necessities early, that’s earlier than January First of subsequent yr.
Some methods to deal with these issues are to start out by asking your state to guard older adults and different Medicaid enrollees by minimizing the compliance and reporting intervals and never implementing work necessities early. To make sure your state does this and would not change its thoughts in a while, we advocate getting your legislature concerned, and work on placing these protections into state legislation. I need to spotlight Nebraska Appleseed right here, who has been working with companions to introduce three payments of their state geared toward mitigating protection loss below H.R.1, and work necessities particularly.
The payments are linked right here on this web page, and they’re considerably overlapping however they embrace issues like prohibiting the state from implementing work necessities early or requiring extra frequent verification than the federal legislation requires, requiring the state to undertake all doable exemptions, defining medically frail as comprehensively as doable, accepting self-declarations as verification of exemption, maximizing efficient ex parte processes, gathering information. That is actually essential.
The invoice would require assortment of knowledge on all kinds of issues, however together with how many individuals are shedding protection due to the crimson tape of labor necessities. You should use these payments as fashions in your state. So once more, the hyperlinks to the payments are there. They supply an excellent place to begin to attempt to get related laws launched in your state. And Sarah at Nebraska Appleseed has provided to be a useful resource. Should you’re seeking to work on related laws, I would be pleased to attach you with Sarah. And likewise our colleagues in California are engaged on laws to guard Medicaid enrollees from improper protection loss below H.R.1. So please attain out in case you’re curious about studying extra.
We have additionally seen challenges with how states are implementing or describing how they are going to implement the person exemptions. We have seen states are deciphering exemptions incorrectly or too narrowly. So for instance with the medically frail exemption, we have seen states placing in language that will apply the Social Safety incapacity definition or related standards to medically frail. Utilizing standards equivalent to incapacity to work as a consequence of a incapacity as what somebody would wish to indicate to be eligible for this exemption. That isn’t what’s in H.R.1.
We have additionally seen states conflating classes or misstating the statute. So the classes of medically frail that Gelila mentioned, they may not be itemizing all of these out. And particularly that final class that, as Gelila stated, needs to be a catchall class of great or advanced medical situations. Simply ensuring that your state has that on the listing as its personal class, to guard individuals who do not match into one other class. We have additionally seen states placing out insurance policies and data that would cut the Caregiver Exemption. So we have seen lots of use of dependent or caretaker-relative language solely, and never speaking about household caregivers.
We have seen lots of deal with kids and the parent-child caregiving relationship, however not caregiving for older adults. We have seen states suggesting that they might require somebody, the care recipient, to be disabled or have a selected medical prognosis for his or her caregiver to obtain an exemption. Once more, this isn’t in HR-1, and we’d urge states to be extra versatile with this Caregiver Exemption.
Some advocacy methods listed below are, once more, to interact your state as they’re growing these insurance policies and supplies. So you may ship a letter to your state. We have now a template that I will go over later, however it’s actually essential to ask to evaluate the supplies earlier than they’re finalized. So these are issues just like the Medicaid functions, notices. Any kind of instructional supplies which can be going out to the general public, in addition to the insurance policies themselves. It is essential to make use of examples as an example the big selection of caregivers and other people with critical or advanced well being situations that states should think about. So this may help keep away from you making an attempt to outline these phrases. As an alternative of defining them for the state, present them who the persons are that have to be exempted.
Okay. Ex parte evaluate. I stated I’d get into extra element about what that is. So ex parte is when the state makes use of current information inside their techniques to confirm eligibility. It is an current course of that states already use for Medicaid. Some examples of ex parte information that could be used is payroll information that might present somebody has labored not less than 80 hours a month, or SNAP information. Usually, ex parte is beneficial and actually helps. It helps keep away from sophisticated paperwork, permits for a few of that automated verification to occur so that folks may be recognized with as minimal burden as doable. And H.R.1 actually requires states to make use of ex parte processes and information to confirm compliance or to confirm that somebody is exempt every time doable.
The problem is ensuring this information and course of is just not used incorrectly. A method it might be used incorrectly is to routinely exclude somebody from an exemption. So for instance, as we spoke about, individuals who have a well being situation, have a incapacity, are caregiving, they usually are working, and payroll information could present that they’re working. However that information, the truth that they’re working, shouldn’t be used to deem them ineligible for an exemption.
The opposite concern is states over-relying on information for exemptions particularly. Folks should have the choice to determine themselves as eligible for an exemption on an utility, and that declaration shouldn’t require additional verification when there aren’t any information sources to confirm. Some advocacy methods listed below are, once more, to contemplate laws or different advocacy to encourage strong use of ex parte information to confirm each work and eligibility for exemptions wherever doable. Additionally, urge your state to just accept self-declarations to confirm eligibility for exemptions, notably for caregivers and individuals who qualify as medically frail. H.R.1, once more, permits and encourages states to scale back the burden, would permit a state to make use of a self-declaration with out additional verification. And so it is essential that states take this feature.
After which actually, actually essential right here is to induce your state to check its techniques, notably round information and verification, earlier than they implement work necessities. Is the system accurately figuring out the categorically-excluded teams and routinely excluding them? Are the ex parte information sources figuring out exempted people? Many states are going to be counting on distributors, third-party distributors to implement all of this. And sadly these distributors have been proven to be problematic on the subject of verifying eligibility within the Medicaid program. So testing and accountability is de facto essential.
I’ll go over a few of our advocacy instruments and extra assets. We have now a work necessities toolkit that, once more, is concentrated on mitigating the harms for older adults, however we predict it is relevant past that and urge you to make use of it and share it and adapt it nonetheless is useful to you and your shoppers and communities. It features a template letter with suggestions that may be personalized. And I’ll go over that letter right here. This slide reveals an image of the letter. And once more, we encourage you to customise it as a lot as doable. Solely use the components that make sense in your neighborhood, and mix it with different templates and assets from different organizations to deal with your state. The bracketed and highlighted data on this letter are locations to fill in your state’s particular info.
So on this letter and all through your advocacy, as I discussed earlier than, utilizing examples is de facto essential. We have heard from the Facilities for Medicare and Medicaid Companies and from state Medicaid companies that examples are actually useful. So we need to use examples as an example who exemptions ought to cowl. So who would possibly the state not be occupied with as medically frail? Who may need boundaries to working 80 or extra hours each month? Who’re the older adults in your neighborhood who depend on Medicaid and have retired early? Why did they retire early? Present that with examples. Who’s caregiving however won’t determine themselves as a caregiver? And who’re they caregiving for? Older adults or different people who could not determine as having a incapacity.
KFF has a piece necessities tracker on-line, they usually have some quotes from Medicaid Enlargement enrollees in that toolkit that I believe actually assist illustrate why examples are essential to indicate states who they have to be occupied with. The primary instance is from a 52-year-old man who says, “I do self-work with Instacart as a result of I get to select and select the times I can work. And coping with my dad, getting in that nursing house, and likewise coping with my mother now, as a result of she’s moving into that section the place she’s needing extra physician appointments.”
So this individual is clearly a caregiver for his dad and mom, his growing old dad and mom, however he isn’t figuring out himself as a caregiver. However he ought to be capable of try this in his Medicaid utility or renewal, to say, “Oh, sure. I’m caring for my dad and mom. And that is why I want Medicaid. And it impacts the work that I do.” So I believe it is a good instance of displaying that caregivers each, they do work, however their caregiving duties are additionally there and may qualify them for an exemption from the work necessities.
The subsequent quote is from a 51-year-old lady who says, “Ever since I have not been working, I have not been capable of finding a job that is authorized or first rate sufficient for working from house. All of them need any individual within the workplace to face up or sit down for lengthy intervals of time. I am unable to even stroll to my car with out being in ache, or get right into a car and drive that car due to the stress all behind that.” So this individual needs to be eligible for the medically frail exemption. It reveals the wrestle with the sorts of work which can be accessible to individuals who depend on Medicaid, and to older adults particularly. And that Medicaid is that this individual’s supply of well being protection. They want Medicaid so as to deal with these situations and their ache.
The opposite advice for this letter and your entire advocacy is to incorporate as a lot state-specific information as doable. I wished to focus on information from AARP and the Nationwide Alliance for Caregiving that’s notably related to older adults and caregivers that we talked about as we speak. So AARP has an interactive map the place you may see what number of older adults, ages 50 to 64, depend on Medicaid Enlargement in your state. AARP and NAC have caregiving state information profiles. And the third useful resource talks particularly about household caregivers and what number of depend on Medicaid in your state. We have now some extra assets. These are all included in our toolkit as properly, so I am not going to spend so much of time, however these go into much more element on the intense or advanced medical situation, in addition to caregiving and all the opposite points and issues, modifications and cuts that had been handed as a part of H.R.1, that we’re monitoring.
So what are subsequent steps as advocates? Now’s actually the time to be reaching out to companions, participating along with your state, and fascinating your state and federal elected representatives about your issues with work necessities and the way they’re being applied. It is also the time to share supplies with others in your neighborhood to fight misinformation about these upcoming modifications, and to proceed to be looking out for extra steerage from the federal authorities in addition to your state. And Justice In Getting older will likely be sharing extra on any steerage and data that we get with our community, so be sure you’re signed up for our emails.
And earlier than we take a couple of query and solutions, we’ve a query for you. A ballot query to be taught extra about what advocacy methods you’re presently utilizing. So the ballot needs to be up. And the choices are letters and/or conferences with state policymakers, becoming a member of a coalition or making new partnerships, growing or advocating on state laws, educating shoppers and the general public, or one thing else. And you’ll inform us what you are doing within the query and reply. We’d love to listen to different concepts as properly. And I understand a lot of you’re in all probability doing a number of issues on this listing, so share one that you simply’re most enthusiastic about or that you simply really feel has been profitable, or perhaps one thing new you are going to attempt.
So we’ll give of us one other few seconds to reply that ballot, after which we will share the outcomes. All proper. It appears like educating shoppers and the general public is by far the highest technique. 72% of you answered that. Subsequent highest is letters and conferences with state policymakers, becoming a member of coalitions and partnerships. A number of persons are growing or advocating on state laws. That is nice to listen to. And likewise I hope that we will get these numbers up after this webinar. So thanks all. We are going to put up our questions slide, after which I believe Amber has queued up a couple of questions for us.
Amber Christ: Yeah. And thanks all in your questions. I do need to level out that so a lot of you included questions outlining particular shopper examples. Like, “What if my shopper matches on this?” Or, “What if my shopper is experiencing this?” These are precisely the sorts of tales and examples that Natalie was describing that your policymakers want to listen to to grasp why an exemption… Each how an exemption needs to be utilized, after which how somebody would possibly go about proving that exemption. Or if not the individual proving it, how the state would possibly method getting documentation of that exemption.
So all of these tales are actually illustrative for policymakers in figuring out make these exemptions truly work for folks. So I encourage you all to share these along with your policymakers both by way of a coalition area or your individual letters, and no matter advocacy avenue is smart for you.
So turning to some query and reply. To start with, beginning high-level, we did get various questions. And I believe that is for Gelila. What if I am in one of many 10 states that didn’t develop Medicaid below the Inexpensive Care Act, like a Florida or Kansas or a Texas? Do these work necessities apply there?
Gelila Selassie: Yeah. Good query. These actually simply apply to these 41 states after which the 2 Enlargement-like states of Wisconsin and Georgia. There’s a likelihood {that a} state would possibly attempt to use a waiver or another funky Medicaid pathway to implement these for different Medicaid populations like for caregivers, for different teams like that, however these H.R.1 work necessities are simply particular to the growth and expansion-like populations.
Amber Christ: Okay, nice. And we bought lots of questions on whether or not seniors or folks on Medicare are topic to work necessities. May you simply, once more, evaluate who’s categorically excluded from work necessities below H.R.1?
Gelila Selassie: Yeah. Older adults, people who find themselves 65 and up, who’re below age 19, or who’re Medicare-eligible or entitled, or receiving Medicare or duals, they shouldn’t be in any respect included into this Medicaid work requirement world. Similar for the parents who’re receiving Medicaid on a incapacity pathway or within the age, blind, disabled applications, SSI for being pregnant, postpartum protection. All of these teams which can be getting Medicaid as a result of they match into this very particular class of individuals shouldn’t be below that world in any respect. So once more, they should not must show something relating to any particular person exemptions.
Amber Christ: Yeah. So once more, actually it is the Enlargement inhabitants, folks ages 19 to 64 who’re eligible by way of the Medicaid Enlargement pathway. However to be clear, it’s doable that the way in which that the state operationalizes work necessities, that people who find themselves imagined to be categorically excluded might get wrapped up on this. And so we need to guarantee that folks perceive that they are truly not topic to those work necessities within the occasion that they get a discover about being topic to them. So simply need to level that out, that they are imagined to be categorically excluded, however it is a actually large change and Medicaid techniques are actually sophisticated. And it is nonetheless doable for people who find themselves not imagined to be topic to those in any respect to get wrapped up in it.
Folks additionally had lots of questions on state flexibility. Can states create their very own exemptions or waive necessities below the legislation? And so might we converse to that?
Natalie Kean: Yeah. That is Natalie. I can reply that. The Statute itself says that states can’t waive something within the Statute for work necessities. So meaning states can’t choose out of implementing work necessities for the Medicaid Enlargement inhabitants. They can’t add exemptions that aren’t within the Statute. They’ll select to make these exemptions as complete and beneficiant as doable, however they can not… For instance, they can not say, “We need to exempt everybody age 50 and older.” That isn’t allowed below the federal legislation. So there may be restricted flexibility for states. And as Gelila hinted at, some states might use these different unusual Medicaid maneuvers, waivers to develop Medicaid work necessities to different populations, however there’s little or no {that a} state might do to exempt or additional exclude populations from work necessities.
Amber Christ: Thanks. Folks additionally had lots of questions on proof. How persons are going to show that they are both assembly work necessities or volunteering, or how they might show exemptions. And so are you able to share, simply high-level, the place we’re when it comes to understanding that form of proof piece? As a result of I believe that that is the place issues are actually going to get operationalized.
Natalie Kean: Yeah. I believe we’re nonetheless on the level, particularly on exemptions, of eager to, once more, encourage states to permit as a lot self-declaration as doable so that folks can get the exemption in place and never must provide you with paperwork or information that merely won’t exist to show that they’re actually eligible for an exemption. So we do not know but what the proof will imply. Confirm has many alternative meanings within the Medicaid context. And we all know that there should be some verification, however the individual’s personal identification, their very own information of their life is one option to confirm that they’re eligible for an exemption, or it needs to be a method.
Amber Christ: And once more, one other space for advocacy is encouraging your states to make that verification as least burdensome as doable, self-declaration being the least burdensome. We had some questions across the household caregivers and the definition of household caregivers and the Caregiver Exemption. And I believed that this was simply an fascinating query when it comes to illustration. What may be thought of a big relationship? And whether or not there’s been any steerage from CMS on the Caregiver Exemption. And I believed perhaps we might simply broadly converse to the Caregiver Exemption and among the issues we all know and do not know. And once more, emphasize the place we would like folks to be pushing their states when it comes to that definition.
Gelila Selassie: Yeah. I can soar in. Once more, we actually do not have a lot info from CMS concerning the particulars of the caregiver relationship, or the documentation or verification that is required. We hold reiterating that Congress deliberately included that RAISE Act definition, which could be very broad. It’s totally broad not solely to the person who’s receiving care, but additionally the kind of relationship.
So when it comes to our advocacy alternatives, it is actually essential to raise that as a result of that is among the higher methods of capturing the best group of caregivers. It would not must be a detailed, intimate member of the family and something like that below the RAISE Act. In order that’s why we hold elevating that, to guarantee that states are conscious that that is what Congress put in. They might’ve utilized a special definition, a extra restricted definition, however they did not. And it is a broad definition. In order that needs to be utilized with respect to the caregiving relationship. Does not must be an grownup little one or a romantic companion or something like that below the Caregiver Act. After which once more, additionally that it applies past simply individuals who determine as disabled.
Amber Christ: Nice. I believe we’re proper at time, so I simply need to thank all people for his or her participation within the webinar and for your entire questions. As each Natalie and Gelila acknowledged, please keep related to us by signing up for our listserv in case you’re not already. As we do get extra steerage from the Facilities for Medicare and Medicaid Companies and as we be taught extra about how particular person states are implementing work necessities, we will likely be sharing extra assets and data. So thanks once more for collaborating, and have an exquisite afternoon.
