Health and Human Services Secretary Alex Azar on Friday gave Indiana permission to begin requiring Medicaid patients to work or engage in a similar activity like volunteering in order to qualify for health coverage.
Coming on the heels of CMS' approval of Kentucky's waiver Jan. 12, Indiana becomes the second state allowed to impose a work requirement. Azar, at a press conference flanked by Republican Indiana Gov. Eric Holcomb at Sidney & Lois Eskenazi Hospital in Indianapolis, said more states could follow.
Seven other states have applied for the so-called Section 1115 waivers to require work, according to the Kaiser Family Foundation. But Azar said a total of 11 states, headed by governors "on both sides of the aisle," have discussed imposing the requirement with the department.
The waiver approvals "seem to be generating a great deal of excitement," said Azar, who was confirmed as HHS secretary Jan. 24.
The shift in federal policy under the Trump administration is also generating a great deal of controversy.
Critics question whether imposing new requirements that could lead to the poor losing health coverage enhances Medicaid as the waivers are required to do.
Leonardo Cuello, health policy director for the National Health Law Program, one of three groups challenging Kentucky's waiver in court, said he will consider challenging Indiana's waiver as well if it violates the law in the same way as the groups believe the approval of Kentucky's waiver does.
However, Azar defended the requirement, saying work would create a "pathway out of poverty." He added, "having healthy lives requires more than health care but a sense of purpose work provides."
According to the state, about 400,000 low-income people in the state receive health coverage through the Healthy Indiana Plan. As many as 130,000 are considered "able-bodied adults," and will be subject to the work requirement, beginning next year.
The waiver also is one of several that allows the state to use Medicaid funds for drug treatment at inpatient clinics with 16 or more beds. The state would allow Medicaid recipients to get drug treatment at 15 more clinics in the state, and 12 others could expand the number of patients it can see because of the change.
