Clark County Medicaid recipients gain extra time before work checks begin

Medicaid recipients in Clark County will not face immediate loss of coverage if they fail to meet new work requirements.

The Centers for Medicare and Medicaid Services informed state directors on Friday that states can wait until July 1 to remove individuals from the program for non-compliance. The national policy was originally scheduled to take effect on January 1. This delay gives local social service departments additional time to update staffing, training, and technology systems.

Under the current rules, most beneficiaries must work or volunteer at least 80 hours a month or attend school half-time. The mandate applies to adults enrolled through the federal expansion in 40 states, which targets lower-income individuals without children in the home. Exceptions exist for those over 64, people caring for children under 14, and those deemed medically frail.

Kathy Hempstead, a senior policy officer for the Robert Wood Johnson Foundation, told The Associated Press that the extra time should reduce administrative errors. She said, “I think these extra six months are going to give states the ability to respond to the change, and there will be fewer people that lose their coverage due to administrative failures.” Kate McEvoy, executive director of the National Association of Medicaid Directors, said state leaders appreciate the flexibility provided by the federal agency.

The delay also offers Congress time to consider changes to the requirement. Democrats, who took control of both chambers in January following recent election victories, have expressed intent to roll back the work rules. This week, Sen. Ron Wyden of Oregon and Rep. Frank Pallone Jr. of New Jersey wrote to CMS Administrator Dr. Mehmet Oz requesting a delay. Their letter cited a recent Boston federal court decision stating that medically frail people should not be bound by the work qualification rules.

Nebraska provides a preview of the challenges states face. The state launched its work requirements in May. Preliminary data presented to the state’s Medicaid Advisory Committee showed that more than 9 in 10 people due for renewal in July and August qualified for continued coverage. However, 533 people were denied coverage. For most of these denials, the reason was missing paperwork rather than a lack of work. Of that group, only 43 lost coverage because they did not meet the actual work requirement.

Amy Behnke, CEO of the Health Care Center Association of Nebraska, noted that likely eligible individuals may have lost coverage. She said, “There are likely people who are still eligible for coverage who lost it.” The federal government is encouraging states to use data from other departments to verify employment, aiming to reduce the burden on beneficiaries to provide proof.

Critics argue that most enrollees are already working and that paperwork is the primary barrier to maintaining coverage. The federal government's new guidance allows states to start the verification process now but delays the consequences until the summer. This approach aims to ensure systems are ready before anyone is officially denied benefits.