Prior to Medicaid expansion, many of these workers simply went uninsured, and too often missed out on needed care - and they still do in states that haven't expanded the program.
The Centers for Medicare and Medicaid Services released new guidelines that allow states to require a Medicaid recipient to work in order to get their health care coverage.
An HHS official, who spoke on the condition of anonymity because the official had not been authorized to discuss the developments, said the agency may approve Kentucky's request as early as Friday.
"Kentucky is leading the nation in this reform in ways that are already replicated by well over a dozen states and growing", he said.
"The idea that we should keep doing what we're doing is an insult to the people of Kentucky".
For people in exceptionally vulnerable positions - say, someone who just lost his job after failing a drug test and can't find an available space at a substance abuse program in his area - adding another bureaucratic hurdle could make it even more hard to get back on track. Whether called "work requirements" or "community engagement", these bureaucratic provisions will be costly and time-consuming. Also off the hook are the more than 10 million enrollees who have a disability. People working 120 hours a month are also exempt.
In an interview on Wednesday, Sununu talked about the need for a New Hampshire Medicaid plan. But in a speech to the nation's Medicaid directors in November, Verma said adding non-disabled adults to Medicaid was a mistake for a program created to help children, the disabled and pregnant women.
People who gained coverage through Medicaid expansion (who can make up to $16,670 for a one-person family) will have to pay a copay or premium. If they don't, they'll have until a state-determined date to make up those hours. They could also take a financial or health literacy course. And if they haven't done any of those things by that predetermined date, they'll get kicked out of Medicaid for six months and have to reapply.
The Trump administration on Wednesday sent a letter to state Medicaid directors announcing a policy to authorize work requirements for states with what are known as "Medicaid 1115 waivers".
These Medicaid enrollees will have to submit any changes to income and employment information if it affects their Medicaid eligibility. In the remaining, only a small number of people will be subject to the requirements. It allowed states to provide coverage to anyone earning up to 138 percent of the federal poverty level (about $16,600 for an individual).
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Although states claim they won't apply work requirements to those with disabilities, evidence from other programs with similar requirements shows that people with physical and mental health conditions are disproportionately likely to lose coverage.
"Recipients will be able to attest to it themselves", Hunter said at the Kentucky Primary Care Association Conference in Lexington in November.
Medicaid is a federal-state collaboration covering more than 70 million people, or about 1 in 5 Americans, and that makes it the largest government health insurance program.
Democrats and health advocates were both quick to criticize the Medicaid changes. The Obama administration would have never approved such waivers, she added.
One-third of Kentuckians are on Medicaid. Make no mistake: people will die because of this. "Having the participation of a broad array of doctors including those in private practice is important so kids can get care when they need it and that they can have an ongoing relationship with a pediatrician". Either you value life or you don't.
More than 4 in 10 non-disabled adults with Medicaid coverage already work full time. "Instead, this is an effort to transform Medicaid into a work program for low-income adults with healthcare as the prize".
Yet states considering whether to enact the controversial strategy face major hurdles.
"We're exploring a lot of different opportunities for where those funds can come from", Sununu said.
The Trump administration, along with many Republican leaders in Congress, has long supported such a move.
CMS said the new policy seeks to help improve the economic situation of Medicaid recipients.