Should Medicaid Patients be Required to Work?

Patients covered by Medicaid in Kentucky and Indiana could soon find themselves in a difficult position. According to new rules, recipients must complete 80 hours of “community engagement” or risk losing their health coverage.

For those with cystic fibrosis who struggle to breathe, it’s a no-win situation.

Medicaid provides health insurance for about 45 percent of cystic fibrosis patients. Without access to regular medication, their lung function may decrease even more quickly than the 1-3 percent rate at which it already decreases, on average, each year. Not surprisingly, cystic fibrosis comes with debilitating symptoms, such as chronic coughing.

As a result, patients often struggle to stay employed. Yet the new rule requires adults age 19-64 to work, attend job training or school, or volunteer in order to keep their Medicaid coverage.

Patient advocates have questioned the legality of the new rules, filing a lawsuit challenging the president’s authority to grant states permission to enact works requirement. Concerns about trackingbeneficiaries’ compliance have also surfaced.

Across the country, all eyes are on Kentucky and Indiana as they implement the change. As many as 11 other states have petitioned the Centers for Medicare and Medicaid Services for permission to create similar work conditions. More could follow.

The new requirement is just another obstacle for cystic fibrosis patients. Many already face coverage barriers like prior authorization or step therapy, which requires that patients try and fail on an insurer-preferred medication before accessing their doctor-recommended treatment.

In the case of cystic fibrosis, delaying treatment can have long-term or permanent effects. And the new Medicaid requirement further jeopardizes access to treatment by posing a nearly impossible challenge for patients: if you want to maintain coverage for a debilitating disease, you must work for it.

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