Colorado’s Medicaid agency is still trying to sort out who may be exempt from looming federal work requirements that apply to nearly 400,000 people in the state — and how to prove it.
Under H.R. 1, last summer’s Republican legislation known as the “big beautiful bill,” people between 19 and 64 who qualified because of their low incomes in states that expanded Medicaid starting in January.
The Colorado Department of Health Care Policy and Financing estimated about 378,000 people fall into that category, meaning they will have to spend at least 80 hours a month working, volunteering or attending school, or prove that they qualify for an exemption.
The department has a , but it doesn’t include detailed information about who qualifies for an exemption based on their medical condition.
The and attempted to calculate how many people could lose Medicaid coverage because of work requirements, coming up with estimates from nationwide.
H.R. 1 exempted people who are “medically frail,” but didn’t fully define what that meant. Some states interpreted the term as , which could cover a broad swath of the population that has chronic conditions. Colorado hadn’t released information about how it intends to define medical frailty.
A nearly 400-page rule that the Centers for Medicare and Medicaid Services released Monday ended that approach.
The federal agency defines medical frailty as an inability to meet the work requirement, and forbids states from adopting more expansive definitions. Among other things, that means states can’t exempt an entire group of people with a certain diagnosis, such as everyone with cancer or Parkinson’s disease, .
The law also exempts recipients who are pregnant, raising a child younger than 14 or acting as a caregiver for a family member. CMS hasn’t specified how states should determine who qualifies as a caregiver.
Colorado, like other states, started preparing for work requirements shortly after H.R. 1 passed last July, said Adela Flores-Brennan, Medicaid director at the Department of Health Care Policy and Financing.
States had to make assumptions about what the federal government wanted while waiting for guidance, and some of those assumptions likely will prove wrong, she said.
“We’re still going through (the rule) and trying to understand the implications,” she said during a webinar Tuesday.
While Medicaid can see existing members’ medical records, health care providers typically don’t issue an opinion on whether someone can work, and the answer can depend on a person’s skills.
For example, a lifelong manual laborer who now needs to use a wheelchair would have a significantly harder time finding a new job than an office worker with the same mobility limitations — a discrepancy reflected in in their community when making decisions about disability income.
Department of Health Care Policy and Financing staff are still reading the CMS rule and figuring out how they would verify someone’s ability to work, spokesman Marc Williams said.
They should be able to confirm whether someone is a caregiver if they live in the same house as a person who has a disability on record with Medicaid, though the process could be more challenging if the caregiver and recipient live apart, he said.
The state will use existing data about income from federal sources, the Colorado Department of Labor and Employment and the credit rating bureau Equifax to verify people’s compliance when possible, Williams said.
It also has access to information people reported for food and cash assistance, and is working to connect with a clearinghouse that has records of students enrolled at accredited colleges, he said.
Colorado is going to presume that people earning at least $580 a month have met the work requirement, said Marivel Klueckman, the departmentap eligibility division director. They are still waiting for guidance on how to prove volunteer hours, she said.
, about 64% of adults under 65 who were enrolled in Medicaid said they worked at least part-time. Another 29% might be eligible for exemptions, because they said they weren’t working due to caregiving responsibilities, a disability or school attendance.
Studies of Medicaid work requirements in Arkansas found about , mostly because they didn’t understand the rules, and employment didn’t increase. Research on work requirements for and also didn’t find an increase in employment.
CMS Administrator Dr. Mehmet Oz that the work requirements would push people to fulfill their purpose in life, while protecting the program from fraud and preserving it for those with the greatest needs.
“I hope you share this belief that we’re put on this Earth with agency to change our future, change the country’s future and make the planet a better place,” he said. “We’re put here to make a difference, but if you’re sitting at home, which is true for the millions of people who are able-bodied on Medicaid, on average, you’re spending 6.1 hours watching television or just hanging around. That’s not why you’re here. So Congress very wisely said, ‘Let’s get you back into the workforce.'”
Easterseals, a nonprofit working with people with disabilities, released a statement raising concerns about the rule and taking issue with the philosophy underlying work requirements. Having health care opens the door to getting a job, not the other way around, President and CEO Kendra Davenport said.
“These work requirements are a penalty for losing a job, missing a piece of mail or a procedural error — they just cause eligible people to lose the coverage they depend on,” she said in a news release. “That means children and adults with disabilities, older adults, veterans and the family members holding it all together — along with the direct care workers whose jobs exist because Medicaid pays for them.”
