Kentucky becomes first U.S. state to impose Medicaid work provisos

WASHINGTON (Reuters) – Kentucky on Friday became the first U.S. state to require that Medicaid recipients work or get jobs training, after gaining federal approval for the fundamental change to the 50-year-old health insurance program for the poor.

The approval came one day after the Centers for Medicare and Medicaid Services issued policy guidance allowing states to design and propose test programs with such unprecedented requirements.

Kentucky’s waiver, submitted for federal approval in 2016, requires able-bodied adult recipients to participate in at least 80 hours per month of “employment activities,” including jobs training, education and community service.

Most recipients must pay a premium based on income. Some who miss a payment or fail to re-enroll will be locked out for six months. The new rules will go into effect in July, Kentucky state officials said.

“Kentucky will now lead on this issue,” Governor Matt Bevin said at a news conference on Friday. “They want the dignity associated with being able to earn and have engagement in the very things they’re receiving,” he said of Medicaid recipients.

Democrats and health advocacy groups blasted the federal policy on Thursday, saying it would make it tougher for the most vulnerable Americans to have access to health care. The Southern Poverty Law Center liberal advocacy group said it planned to file a legal challenge.

Certain groups are exempt, including former foster care youth, pregnant women, primary caregivers of a dependent, full-time students and the medically frail. The Trump administration also said states would have to make “reasonable modifications” for those battling opioid addiction and other substance-use disorders.

Kentucky, along with 30 other states, expanded Medicaid to those earning up to 138 percent of the federal poverty level under the Affordable Care Act, former Democratic President Barack Obama’s signature domestic policy achievement commonly called Obamacare.

More than 400,000 Kentucky residents gained health insurance through the program, the highest growth rate of Medicaid coverage of any state.

Among adult Medicaid recipients aged 18 to 64, 60 percent already have jobs, according to the Kaiser Family Foundation health policy research group. Most adult Medicaid recipients who do not work reported major impediments as the reason, according to Kaiser.

Kentucky Governor Matt Bevin has said that the program had become financially unsustainable under Obamacare, although the federal government covers the majority of its cost. The waiver is projected to reduce the number of people on Medicaid by nearly 86,000 within five years, saving more than $330 million.

At least nine additional states, mostly Republican led, have proposed similar changes to Medicaid: Arizona, Arkansas, Indiana, Kansas, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

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HR3722 `Putting Drug Free Families First Act of 2011′

HR 3722 IH

112th CONGRESS

1st Session

H. R. 3722

To amend part A of title IV of the Social Security Act to require States to implement a drug testing program for applicants for and recipients of assistance under the Temporary Assistance for Needy Families program.

IN THE HOUSE OF REPRESENTATIVES

December 16, 2011

Mr. PEARCE (for himself, Mr. WESTMORELAND, Mr. ROE of Tennessee, Mr. DUNCAN of South Carolina, Mr. DESJARLAIS, Mr. HUIZENGA of Michigan, Mr. POSEY, Mr. KING of Iowa, and Mr. MULVANEY) introduced the following bill; which was referred to the Committee on Ways and Means


A BILL

To amend part A of title IV of the Social Security Act to require States to implement a drug testing program for applicants for and recipients of assistance under the Temporary Assistance for Needy Families program.

    Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
    This Act may be cited as the `Putting Drug Free Families First Act of 2011′.
SEC. 2. DRUG TESTING PROGRAM FOR APPLICANTS FOR AND RECIPIENTS OF ASSISTANCE UNDER STATE TANF PROGRAMS.
    (a) Requirement That Applicants and Individuals Receiving Assistance Be Tested for Illegal Drug Use- Section 408(a) of the Social Security Act (42 U.S.C. 608(a)) is amended by adding at the end the following:
      `(12) REQUIREMENT FOR DRUG TESTING; DENIAL OF ASSISTANCE FOR INDIVIDUALS FOUND TO HAVE USED AN ILLEGAL DRUG-
        `(A) IN GENERAL- A State to which a grant is made under section 403 may not use any part of the grant to provide assistance under the State program funded under this part to an individual unless the individual is tested for the use of the drugs listed in subparagraph (B)(i)–
          `(i) if the individual has applied for such assistance and the application has not been approved, before the receipt of such assistance; and
          `(ii) in any other case, before the end of the 3-month period that begins on the date of the enactment of this paragraph.
        `(B) DRUGS TO BE INCLUDED IN TESTING-
          `(i) IN GENERAL- In conducting drug testing pursuant to subparagraph (A), the State shall test for each of the following:
            `(I) Marijuana.
            `(II) Cocaine.
            `(III) Opiates.
            `(IV) Amphetamines.
            `(V) Methamphetamine.
            `(VI) Phencyclidine.
            `(VII) Heroin.
            `(VIII) Lysergic acid diethylamide.
            `(IX) 3,4-methylenedioxy amphetamine.
          `(ii) EXCEPTION FOR PRESCRIPTION USE OF DRUGS- A positive test for a drug listed in clause (i) shall be disregarded for purposes of this paragraph if such drug was used pursuant to a valid prescription or as otherwise authorized by law.
        `(C) DENIAL OF ASSISTANCE FOR INDIVIDUALS WHO TEST POSITIVE FOR AN ILLEGAL DRUG-
          `(i) IN GENERAL- Except as provided in subparagraph (D), if an individual tests positive pursuant to subparagraph (A) for the use of any drug listed in subparagraph (B)(i), the State may not provide assistance under the State program funded under this part to such individual unless–
            `(I) a 1-year (or, if the individual has so tested positive for the 2nd time, 3-year) period has elapsed since the results of the test were determined; and
            `(II) the individual tests negative for the use of each drug listed in subparagraph (B)(i) at the end of such period.
          `(ii) PERMANENT INELIGIBILITY AFTER THIRD POSITIVE TEST RESULT- If an individual tests positive pursuant to subparagraph (A) for the third time for the use of any drug listed in subparagraph (B)(i), the State shall treat such individual as permanently ineligible for assistance under the State program funded under this part.
        `(D) REHABILITATION EXCEPTION AFTER FIRST POSITIVE TEST RESULT- In the case of an individual who tests positive pursuant to subparagraph (A) for the first time for the use of any drug listed in subparagraph (B)(i), the period for which assistance may not be provided to an individual by reason of subparagraph (C)(i) shall be 180 days if the State determines that the individual–
          `(i) has successfully completed a drug rehabilitation or treatment program for the drug for which the individual tested positive; and
          `(ii) tests negative for the use of such drug at the end of such 180-day period.
        `(E) PAYMENT OF COSTS- The State shall require each individual who applies for assistance under the State program funded under this part to pay the portion of the cost of the drug testing pursuant to subparagraph (A) that pertains to such individual. If such individual tests negative for the use of each drug listed in subparagraph (B)(i) and the State provides assistance under the State program funded under this part to the individual, the State shall increase the first payment of such assistance in an amount equal to the amount paid by the individual under this subparagraph for the drug testing.
        `(F) DESIGNEE FOR CHILD BENEFICIARY- In the case of a parent of a minor child, if such parent tests positive pursuant to subparagraph (A) for the use of any drug listed in subparagraph (B)(i), the State shall designate an individual other than such parent to receive payments for assistance under the State program funded under this part on behalf of the minor child. The State may not so designate an individual unless the individual has been tested for the use of each drug listed in subparagraph (B)(i) and did not test positive.
        `(G) DEFINITION OF DRUG REHABILITATION OR TREATMENT PROGRAM- In this paragraph, the term `drug rehabilitation or treatment program’ means a program that–
          `(i) has been determined by the State to provide rehabilitation or treatment for the use of an illegal drug; and
          `(ii) complies with all applicable Federal, State, and local laws and regulations.’.
    (b) Penalty for Failure To Implement Illegal Drug Use Testing Program- Section 409(a) of the Social Security Act (42 U.S.C. 609(a)) is amended by adding at the end the following:
      `(16) PENALTY FOR FAILURE TO IMPLEMENT ILLEGAL DRUG USE TESTING PROGRAM- If the Secretary determines that a State to which a grant is made under section 403 in a fiscal year has violated section 408(a)(12) during the fiscal year, the Secretary shall reduce the grant payable to the State under section 403(a)(1) for the immediately succeeding fiscal year by an amount equal to 10 percent of the State family assistance grant.’.
    (c) Effective Date- The amendments made by this section shall take effect on the 1st day of the 1st calendar quarter that begins on or after the date that is 1 year after the date of the enactment of this Act.

END

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Trading Sex for a "F–cking Happy Meal?

Mom Can’t Get Food Stamps After Drug Offense, Resorts to Prostitution to Feed her Kids

If she’d committed murder, Carla could have gotten assistance to feed her children. But because the crime she committed was related to drugs, she can’t.

December 21, 2012  |  

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Carla walked into my office with despair in her eyes. I was surprised. Carla has been doing well in her four months out of prison; she got off drugs, regained custody of her kids, and even enrolled in a local community college. 

Without much prodding she admitted to me that she had retuned to prostitution: “I am putting myself at risk for HIV to get my kids a f—ing happy meal.”

Despite looking high and low for a job, Carla explained, she was still unemployed. Most entry-level jobs felt out of reach with her drug record, but what’s worse, even the state wasn’t willing to throw her a temporary life preserver.

You see, Carla is from one of the 32 states in the country that ban anyone convicted of a drug felony from collecting food stamps. With the release of the Global Burden of Disease Study last week, it bears looking at how we are perpetuating burdens among the most vulnerable Americans with our outdated laws.

If she’d committed rape or murder, Carla could have gotten assistance to feed herself and her children, but because the crime she committed was a drug felony, Carla joined the hundreds of thousands of drug felons who are not eligible.

The 1996 passage of the Welfare Reform Act was supposedly implemented to prevent drug addicts from selling their food stamps for drugs. But that concern is virtually unwarranted today. Unlike old food-stamp coupons, today’s food stamps are distributed electronically, which makes selling or trading them quite difficult.

Nonetheless, the law persists.  According to the U.S. Department of Agriculture, nine states have a lifetime ban for food-stamp eligibly for people convicted of drug felonies.  Twenty-three states have a partial ban, such as permitting eligibility for persons convicted of drug possession but not sale, or for persons enrolled in drug treatment programs.

Denying food stamp benefits to people convicted of drug offenses is an excessive and ineffective crime control strategy. The policy increases an individual’s risk of returning to prison by making it more difficult for people to survive after they get out, slowing or possibly even preventing their reintegration into society. People without the financial cushion necessary to get through the initial period of job searching and re-establishing a life have little choice but to turn to illegal means to make ends meet.

What’s more, the food-stamp ban is a law that works against good public health policy. As a doctor who cares predominantly for people who are released from prison, I see the damaging consequences of this ban on food stamps. I have seen patients of mine with diabetes go without food and end up hospitalized with low blood sugar, and still others with HIV skip their antiretrovirals because they don’t have food to take with their pills.  Not having access to food is associated with bad health outcomes including worsening diabetes, HIV, depression. Young children face anemia, diabetes, and depression.

Women with children are especially affected. It’s estimated that 70,000 women and their children are banned from obtaining food stamps. This means mothers who are simply trying to feed themselves and their children, and who are trying to get back on their feet after serving their time, are banned from receiving the money to pay for the basics necessary to survive.  Meanwhile, 46 million others, including college graduates and PhDs with far more resources, can receive food aid.

No other criminal conviction results in such a ban—not arson, not rape, not even murder.

Carla was arrested at 20 for selling marijuana.  At the time, she had also been making money working for her “boyfriend” as a sex worker.  Her boyfriend was also arrested for robbery.  He could qualify for food stamps upon release. But not Carla. She continues to pay for selling marijuana— a drug which two states have now voted to legalize outright—and the price is health risks for herself and for her children. 

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