Exemptions, Premiums, and Support: A Glimpse into Possible Medicaid Work Requirements

Sep 20, 2018


Hundreds line up in the early morning to attend the Remote Area Medical (RAM) clinic in Smyth County, Va. Many who depend on the clinic for care will soon be eligible for healthcare under Medicaid expansion. But that expansion will also come with new eligibility requirements.
Credit Jacquelyn Martin / AP


Virginia is moving forward with a plan to implement work requirements for Medicaid. Lawmakers got their first glimpse of details for the program during a Senate Finance committee meeting in Richmond Thursday.

Lawmakers voted to expand Medicaid and implement a new set of reforms to the program during last year's General Assembly. They left the state agency in charge of Medicaid with a broad directive: to create a work requirement program. Details on what that program would look like were left up to the agency. 

Now lawmakers are getting their first look at the specifics.  Virginia's Department of Medical Assistant Services, or DMAS, has finished a first draft proposal of the program. That proposal now goes public for a 30-day input period before DMAS submits it to the federal government for approval. 

Approval from the federal government could take some time. In other states approval has taken upwards of a year, or been held up by lawsuits. Virginia can't roll out the program until it has approval.

The state will, however, expand Medicaid eligibility beginning January 1st, even if the work requirement program is not yet in place.  

Here's what the proposal includes: 

• Two new requirements to be eligible for Medicaid: working, and paying small monthly premiums

• Seeking job training, vocational training, certain nonpolitical community service, and caregiving would all fulfill the work requirement

• Exemptions: children, college students, people who are disabled, pregnant women, primary caregivers, victims of domestic violence, the "medically frail", and anyone already meeting work requirements to recieve SNAP or TANF benefits

• Individuals can also get exemptions based on certain qualifying live events, including: death of a family member, hospitalization, severe weather, a family emergency, or living somewhere with high unemployment

• Work requirements are not full-time. They are 20 hours of qualifying activity 3 months after enrollment, 40 hours 6 months after enrollment, 60 hours 9 months after enrollment, and 80 hours 12 months after enrollment

• No compliance mechanism for work requirements is outlined. Dr. Jennifer Lee, Director of DMAS, says those specifics still need to be worked out

• Monthly premiums of $5 to $10 for people earning more than the poverty level. Small co-pays for non-emergency visits

• If someone fails to comply or to pay premiums three months out of the year they will lose coverage. They can gain coverage again as soon as they show they are in compliance. There is no lock-out period. 

• In addition to the new requirements, the program will also provide new supports. Those include help with housing, transportation, and finding work for qualifying individuals.

The full waiver is available here