Still, critics fear a work requirement could have a chilling effect on people signing up for Medicaid or make it harder for people to get coverage.
The Maine Department of Health and Human Services a year ago sought federal Medicaid officials' permission to require non-disabled, low-income adults enrolled in Medicaid to work as a condition of receiving coverage. In a letter released Friday, CMS Principal Deputy Administrator Demetrios L. Kouzoukas outlines groups exempt from the requirements: former foster care youth, pregnant women, primary caregivers of a dependent, the medically frail, full-time students, and those diagnosed with an acute medical condition that would prevent them from complying with requirements.
It's a "large and sharp reversal" from Medicaid in the past, says Judith Solomon, vice president of health policy at the Center on Budget and Policy Priorities.
"CMS recognizes that a broad range of social, economic, and behavioral factors can have a major impact on an individual's health and wellness, and a growing body of evidencesuggests that targeting certain health determinants, including productive work and community engagement, may improve health outcomes", read the letter from Brian Neale, CMS' Medicaid director.
Researchers examined the proportion of pediatricians accepting Medicaid before and after payments increased in 2013 and 2014 - and found gains in participation nationwide as well as in most studied states.
Additionally, there's not consensus the programs are effective at getting people into jobs, said Joan Alker of Georgetown University during a conversation in Lexington, Kentucky in November.
Kentucky Is the First State to Enact Medicaid Work Requirements
The acronym HEALTH stands for "Helping to Engage and Achieve Long Term Health".
Ten states - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, Mississippi, New Hampshire, Utah and Wisconsin - have already requested a waiver from CMS so they can add work requirements to Medicaid.
A study found the proposal would reduce the number of residents on Medicaid by almost 86,000 within five years, saving more than $330 million. The broadening of Medicaid to low-income adults under Obamacare - roughly 11 million have gained coverage under the health reform law's Medicaid expansion provision - further spurred GOP efforts.
But work requirements aren't the only idea that states have for health care, and it remains to be seen just how much flexibility CMS will give. In the past, federal officials said work was not among those objectives. Besides employment, it can include job training, volunteering or caring for a close relative. That's because children - who make up almost half of Medicaid enrollees - are excluded.
Many consumer groups, patient advocates and physicians around the country have decried the Trump administration's moves to put the new requirements on Medicaid recipients, arguing the mandates are inconsistent with the program's core mission to provide health coverage.
But work requirements have strong public backing. Kentucky's expansion brought health coverage to more low-income adults, but the state's Republican Governor, Matt Bevin, has expressed his dislike for the expanded program.
Failure to pay a premium after a 60-day grace period would result in them losing coverage and being unable to enroll again for six months unless all past due and current premiums and the beneficiary completes a "state-approved health literacy or financial literacy course".
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