Medicaid recipients ages 19-64 will have to prove they are working or going to school 80 hours a month or qualify for an exemption. One exemption is for “medical frailty,” which applies to people with serious health conditions. But under a new rule issued earlier this month, recipients must prove their condition “significantly impairs” their ability to meet the work requirements, rather than simply showing they have the condition.
Aaron Wernham, CEO of the Montana Healthcare Foundation, said it is not what most states were expecting.
“You’ll have to not only know the person’s diagnosis, which you can figure out from Medicaid claims, and that’s what states were planning to do, but you’ll also now actually have to have some way of understanding, are they able to work or not?” Wernham explained. “That’s not an easy thing to figure out.”
States will allow people to self-attest their medical conditions for the first year. Afterward, documentation will be required.
Wernham acknowledged it is unclear what documentation Montana will require and how the state will process the additional paperwork. The Centers for Medicare and Medicaid Services is taking public comment on the medical frailty rule through July 31.
Wernham expects many people will lose Medicaid coverage because of the new rule, not because they do not qualify but because of the burden of proving they are meeting the requirements or cannot work. To prepare, he stressed people should watch for and respond to any notices from the state.
“If you have a serious medical illness, it’s being in contact with your provider right away to understand what you’re going to need to do to document that and have your provider ready to help you with that,” Wernham advised.
Wernham is concerned Montana’s health department will struggle with the volume of Medicaid eligibility checks. Given the new rules on medical frailty, he argued the state should take more time.
“Rather than rushing into this, it seems to make more sense, so that people aren’t hurt, for the state to take a little extra time, understand the new rules, and put the systems in place to implement them well,” he contended.
The state health department is still working on defining medical frailty in relation to the program and no final decisions have been made.