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Friday, June 8, 2018

The Ethics of Medicaid’s Work Requirements and Other Personal Responsibility Policies

Harald Schmidt and Allison K. Hoffman
JAMA. Published online May 7, 2018. doi:10.1001/jama.2018.3384

Here are two excerpts:

CMS emphasizes health improvement as the primary rationale, but the agency and interested states also favor work requirements for their potential to limit enrollment and spending and out of an ideological belief that everyone “do their part.” For example, an executive order by Kentucky’s Governor Matt Bevin announced that the state’s entire Medicaid expansion would be unaffordable if the waiver were not implemented, threatening to end expansion if courts strike down “one or more” program elements. Correspondingly, several nonexpansion states have signaled that the option of introducing work requirements might make them reconsider expansion—potentially covering more people but arguably in a way inconsistent with Medicaid’s broader objectives.

Work requirements have attracted the most attention but are just one of many policies CMS has encouraged as part of apparent attempts to promote personal responsibility in Medicaid. Other initiatives tie levels of benefits to confirming eligibility annually, paying premiums on time, meeting wellness program criteria such as completing health risk assessments, or not using the emergency department (ED) for nonemergency care.

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It is troubling that these policies could result in some portion of previously eligible individuals being denied necessary medical care because of unduly demanding requirements. Moreover, even if reduced enrollment were to decrease Medicaid costs, it might not reduce medical spending overall. Laws including the Emergency Medical Treatment and Labor Act still require stabilization of emergency medical conditions, entailing more expensive and less effective care.

The article is here.
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