On the heels of a similar action by scores of lawmakers, 160 healthcare, criminal justice, and civil rights organizations have come out against the Trump administration's allowance and encouragement of states implementing work or "community engagement" requirements for Americans trying to attain Medicaid.

"CMS's new policy cruelly punishes and stigmatizes low-income people—depriving them of the life-saving care that many need to become and remain healthy."

—Gabrielle de la Guéronnière,

Legal Action Center

In a letter (pdf) to Health and Human Services Secretary Alex Azar, the groups assert that the guidance issued last month by the Centers for Medicare & Medicaid Services (CMS), which enables states to impose the requirements, "will have a significant and disproportionately harmful effect on individuals with chronic health conditions, especially those struggling with substance use disorders (SUDs) and mental health disorders, as well as those with conviction and arrest records."

"Individuals may be caught in a bitter catch-22, where they cannot qualify for Medicaid because they do not have documentation of disability, but they cannot get their disability documented because they do not have health coverage," the letter warns. "CMS allowing states to make it difficult for Americans to access vital SUD care through Medicaid likely will increase the devastating impact of the opioid epidemic nationwide."

"The CMS guidance also fails to recognize the stigma, discrimination, and related legal and policy barriers to employment confronting people with criminal records," the letter declares. "CMS's policy will make it even more difficult for people with criminal records to obtain needed physical and mental healthcare services and medications critical to successful reentry."

The letter also points out that "children of parents who are struggling with these conditions, or parents who have conviction and arrest records, will be significantly and negatively affected by the disproportionately harmful effect upon their parents," and that the policy actually impedes efforts by Americans who are struggling with poverty, addiction, or a criminal record, to secure and maintain steady employment.

"Putting obstacles in the way of access to healthcare does not support work but instead puts a critical support for work at risk," the letter notes. "When people are not healthy or able to get needed medications they are less likely to be able to work."

"Children of parents who are struggling with these conditions, or parents who have conviction and arrest records, will be significantly and negatively affected by the disproportionately harmful effect upon their parents."

—Letter to HHS Secretary

Gabrielle de la Guéronnière, director of policy at the Legal Action Center, which helped draft the letter, concluded that "CMS's new policy cruelly punishes and stigmatizes low-income people—depriving them of the life-saving care that many need to become and remain healthy."

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She also noted that the Trump administration "has stated that stemming the opioid crisis and reforming the criminal justice system are key priorities," but "this new CMS policy is totally contrary to achieving both of those important goals."

The groups were praised by critics of the CMS policy, including Andy Slavitt, who oversaw the centers for the Obama administration, and who called out the Department of Health and Human Services for masquerading as the Labor Department.

We need a Department of Health. We already have a Department of Labor. 160 organizations speak out against cutting treatment for people out of work as Trump is now doing with Medicaid. Citing impact on those with mental illness and substance abuse disorders. Orgs follow. pic.twitter.com/iHNJ3PeEdp — Andy Slavitt (@ASlavitt) February 16, 2018

The groups' letter to Azar followed a similar letter (pdf) sent to him by 172 Democratic members of the U.S. House earlier this week. "The reality is that CMS's recent actions," the Democrats wrote, "ignore a fundamental truth: most of those who can work, are working, but many fall through the cracks and lose their coverage due to harsh and inflexible implementation of this ideologically-driven policy."