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Axios
2 days ago
- Health
- Axios
New Medicaid work rules put states in a bind
The new Medicaid work rules in President Trump's tax-and-spending law put states on a tight timetable for setting up systems to notify millions of recipients about the requirements — and to track if they're complying. Why it matters: Previous efforts to set work rules in Georgia and Arkansas showed it could be a messy and expensive process that generally relies on outside vendors to set up the necessary infrastructure. Georgia spent nearly $100 million to implement its rules, $55 million of which went toward building a verification system, but in two years only enrolled a fraction of those eligible. It spent $13,000 per enrollee just to sign them up. State of play: The new law starting in 2027 will require states to condition Medicaid eligibility for able-bodied adults on working, volunteering or doing other qualifying activities for at least 80 hours per month. States have to verify recipients' eligibility monthly and do redeterminations at least twice a year. The new law provides $200 million to states for implementation. The technical requirements, and the compressed time frame for rolling out the rules, will likely leave many states scrambling or applying for extensions, Medicaid experts say. The consequences of failing could be significant. Many of the nearly 12 million people expected to lose coverage under the law will do so because of red tape around work requirements and the inability to show they're complying. 64% of adults with Medicaid already work full time or part time, according to an analysis of census data by the Center on Budget and Policy Priorities. Another 32% are caretakers or are ill or disabled, attend school, or are retired. Between the lines: It's not just a matter of turning a switch on states' existing Medicaid systems, which can be outdated and clunky. There needs to be reliable sources of data that can be integrated in a timely way, experts say. And there's little margin for portal crashes or other technical glitches. "[IT] systems vary from state to state ... and we know from the COVID experience that those unemployment insurance systems are incredibly antiquated in some cases," KFF CEO Drew Altman told reporters in a call last week. "The systems work ... is quite substantial" and could be expensive, he added. Among the challenges is how to track someone's volunteer hours, or if an individual has a varying schedule, like a gig worker. There also are factors like determining the status of a behavioral health problem that could qualify for an exemption. "It sounds simple, but when you're talking about silos, talking to one another, it's just not," Andy Schneider, a Medicaid expert at the Georgetown University McCourt School of Public Policy. Friction point: Georgia has turned into a cautionary tale after the state won a waiver during the first Trump administration with reports that the system was plagued with backlogs of applications, erroneous messages and technical glitches, the Associated Press reported. The state recently stopped checking each month whether beneficiaries were meeting the requirement. "The implementation costs in Georgia are very high, a lot of systems work went into this, and at the end of the day, not nearly as many people were able to enroll in coverage," said Allison Orris, director of Medicaid policy at the Center on Budget and Policy Priorities. Similarly, when Arkansas rolled out work requirements in 2018, individuals on Medicaid were given often conflicting information via multiple letters sent to their home, said Kevin De Liban, who was formerly director of advocacy for Legal Aid of Arkansas. It generally took hours to get through to someone at a customer call center and, often, those people were unable to definitively answer questions about exceptions, De Liban said. "People will lose coverage. There is no way to stop people who should be eligible from losing coverage. That's the lesson of Arkansas; there will be chaos," De Liban said. Medicaid experts say the $200 million in implementation funds are not likely to cover the administrative, operational and communications work that will be needed to roll out the rules. States that can't do implementation in house will find a small group of contractors with experience building enrollment and verification systems with the needed scale, including Deloitte, Accenture and Maximus. De Liban said it's more than just handing over the keys. "The states need to be prepared to sue the contractors when those systems break, because they will break," De Liban said. What to watch: Key exceptions to the work requirements still need to be defined by Health Secretary Robert F. Kennedy Jr. by June 2026. The law has carve-outs for a "'disabling mental disorder" "substance abuse disorder" or "serious or complex medical conditions" but doesn't lay out details — or if states will have leeway to make determinations. Regardless how much discretion states get, Schneider said, the data systems are going to have to sort through potentially millions of names and identify those meeting the final criteria. The bottom line: Some states may conclude it's easier and less costly to unwind their Medicaid expansions than to deal with the cost and bureaucratic hassles of administering work rules. "The people who wrote this were not trying to make anything work. They were trying to make this as difficult as possible because they want states to dump Medicaid expansion altogether or dump as many expansion adults as possible through red tape," Schneider said.
The Hill
17-06-2025
- Business
- The Hill
64 percent opposed to GOP megabill: Survey
Nearly two-thirds of U.S. adults have an unfavorable opinion of President Trump's agenda-setting 'One Big Beautiful Bill Act' that narrowly passed the House last month, a new survey found. The KFF Health Tracking Poll released Tuesday found 64 percent of adults surveyed said, based on what they know about the tax and spending megabill, they do not like it — including the majority of Democrats, independents and Republicans who do not identify with the 'Make America Great Again' (MAGA) wing of the GOP. Just 35 percent of respondents said they view the proposal favorably, with the biggest bloc of support coming from MAGA-backing Republicans, who overwhelmingly approve of the bill at 72 percent. 'The public hasn't had much time to digest what's in the big, beautiful, but almost incomprehensible bill as it races through Congress, and many don't have a lot of information about it,' KFF president Drew Altman said in a statement. 'Our poll shows that views toward the bill and its health-care provisions can shift when presented with more information and arguments about its effects, even among MAGA supporters.' The survey attempted to gauge how much people know about the details of the bill. According to KFF's findings, more than half of people surveyed knew the bill would increase federal spending on border security (58 percent). About half knew it would increase the federal budget deficit (50 percent), decrease federal spending on food assistance for low-income Americans (53 percent) and Medicaid (51 percent). More than a quarter of people surveyed said they 'didn't know' when asked about one of eight specific impacts the proposed legislation would have. Trump has made what he dubbed the 'big, beautiful bill' a centerpiece of his second presidency, pushing GOP lawmakers to roll most of his agenda points into it, but the sweeping legislation has been divisive even among some of the president's staunchest supporters. Trump and Elon Musk had a dramatic falling out earlier this month after the tech billionaire left his role as head of the White House's Department of Government Efficiency (DOGE) and quickly began bashing the proposal as a 'disgusting abomination.' Republican senators are wading through revisions to the House version they want to make before taking a vote on the measure, which Trump wants to have on his desk to sign by July 4. 'We're continuing to have meetings with groups and committees,' Senate Majority Leader John Thune (R-S.D.) told The Hill last week. 'Full speed ahead, a lot of conversations, getting everybody comfortable.' The KFF poll surveyed 1,321 U.S. adults June 4-8. It has margins of error of 3 percentage points for total findings and 6 percentage points on results broken down by party.
Washington Post
30-05-2025
- Business
- Washington Post
Future of health policy in the United States
Jeanne Lambrew Director of Health Care Reform and Senior Fellow, The Century Foundation Drew Altman President and CEO, KFF Additional speakers to be announced. The following content is produced and paid for by a Washington Post Live event sponsor. The Washington Post newsroom is not involved in the production of this content. Mark Bertolini CEO, Oscar Health
Yahoo
07-05-2025
- Health
- Yahoo
Fewer than half of Americans trust the FDA and CDC to do their job, poll finds
Fewer than half of Americans trust in federal health agencies like the Food and Drug Administration and Centers for Disease Control and Prevention to do crucial parts of their job under the Trump administration. Just 42 percent of more than 1,000 people surveyed in a new poll from the non-profit KFF think federal health agencies are effectively able to respond to infectious disease outbreaks. Furthermore, only 45 percent are confident that they could ensure the safety and effectiveness of vaccines approved for use in the U.S., and 46 percent believe that these and other health agencies can ensure prescription drugs are safe and effective for public usage. 'There are remarkably low levels of trust in the nation's scientific agencies, shaped by partisan perspectives, and that presents a real danger for the country if and when another pandemic hits,' KFF CEO Drew Altman said in a statement. The findings come amid heightened vaccine hesitancy that has helped to fuel the recent and deadly West Texas measles outbreak, and moves made by Health and Human Services Secretary Robert F. Kennedy, Jr. in support of alternate treatments and review established science. Less than half of Americans say they trust in federal health agencies to do critical parts of their job. A new poll comes following a major overhaul of the country's science and research programs (Getty Images) While most adults said that they were at least 'somewhat confident' in the safety of routine vaccines — including for the measles (84 percent) and the flu (74 percent) — that number drops significantly when questioned about the Covid vaccine. Indeed, only 56 percent of adults say that are at least 'somewhat confident' that it is safe. One of the reasons behind the lack of confidence is that 60 percent of the public, including Democrat voters, say that the CDC and FDA aren't paying close enough attention to science when making decisions under the Trump administration. Less than a third of respondents said they had confidence in the agencies to act independently without interference from outside groups. Vaccine hesitancy has contributed to the West Texas measles outbreak. The state has seen nearly 700 cases (Getty Images) 'In addition, at least three in ten say these agencies are paying 'too much attention' to the beliefs of officials running the agencies (34 percent) and the interests of pharmaceutical companies (30 percent) when making vaccine-related decisions,' KFF said. Many of the responses fell along party lines. For example, Democrats were more likely to say that they have 'some' trust in government health agencies. While 87 percent of Democrats were at least 'somewhat confident' in the Covid vaccines' safety - just 30 percent of Republicans said the same. But, for Democrats, trust in the agencies to provide vaccine information is declining: falling by double digits since 2023. For Republicans, that's increased by 10 percentage points. 'While Democrats are still more likely than Republicans to trust either the CDC or FDA as a source of vaccine information, the shifts in trust mark a notable reversal in partisan trends first observed during the start of the Covid pandemic,' said KFF.
