Work requirements coming to Medicaid? Presented by

WORK REQUIREMENTS COMING TO MEDICAID? — CMS is developing guidance on how states could use waivers for work requirements in Medicaid, a proposal that would represent a major philosophical shift for the 52-year-old entitlement, POLITICO's Rachana Pradhan reports.

The guidance is expected to be outlined in a letter to state Medicaid directors, individuals with knowledge of the forthcoming proposal tell Rachana. Several GOP states have asked to link Medicaid benefits with employment or other job-related activities — but their requests have languished with federal officials.

— Trump's top health officials have said they want work requirements. CMS administrator Seema Verma and others have previously defended the policy, saying that it's necessary as Medicaid has expanded. For instance, the program now covers millions of low-income adults who aren't disabled and primarily don't have dependent children.

— But support from Verma and others hasn't yet translated into action. At least seven states — Kentucky, Indiana, Arkansas, New Hampshire, Maine, Wisconsin and Kansas — have either already asked the Trump administration to approve Medicaid waivers that include work requirements or will submit proposals shortly.

— A fight is looming. There are still outstanding questions about CMS' forthcoming framework, Rachana tells PULSE, like the types of exemptions that might apply even when a state receives approval.

One outcome is virtually inevitable: lawsuits. Democrats and left-leaning consumer advocate groups have fiercely protested tying Medicaid benefits to employment, arguing that it would set back the program's goal of providing health coverage to low-income Americans.

CMS is readying guidance on how state Medicaid programs can add work requirements. | Getty

A message from PhRMA: Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. More.

PAUL RYAN: REPEAL OF ACA MANDATE 'BEING DISCUSSED' AS PART OF TAX PLAN — The House speaker said on "Fox News Sunday" that there's an "active conversation" about how to improve the tax plan, which could include repealing the Affordable Care Act's individual mandate.

"That's one of the things that's being discussed," Ryan said. "That's among the ideas that a lot of members are suggesting that we could add to this bill to make it even better." See 39-second video clip.

— CBO to weigh in. The budget office's updated score of repealing the individual mandate, which Ways and Means chairman Kevin Brady said he has requested, could come as soon as today. In the last analysis CBO found that repealing the mandate would save more than $400 billion over a decade — which could help Republicans pay for their tax plan — but also leave 15 million more Americans without health insurance. President Donald Trump has pushed for including a mandate repeal in the bill, but Brady and others have said they worry it will make it even harder to get a tax bill through the Senate.

— Ryan also says more entitlement reform is coming. "I wish the ObamaCare bill would have passed, which would have been good fiscal responsibility, entitlement reform legislation," Ryan lamented, noting that his chamber moved a bill that died in the Senate. "We're just going to keep going at entitlement reform all the way down the road."

ADVOCATES LOOK TO MAKE OPIOIDS A TOP ISSUE IN THE 2018 MIDTERMS — Former Rep. Patrick Kennedy is working with advocacy groups and former Surgeons General Vivek Murthy and David Satcher on an effort to hold current lawmakers accountable, POLITICO's Brianna Ehley reports.

— The advocates' plan: To create a legislative scorecard that would hold lawmakers accountable on their response to the opioid crisis ahead of the 2018 midterm elections. Kennedy told Brianna he'll meet with various groups to come up with metrics to measure lawmakers’ commitment to fighting the epidemic, including voting records and who’s donating to their campaigns.

Kennedy said he also wants to examine how to score agency secretaries’ efforts to carry out the recommendations made by the president’s opioid commission, on which he serves.

"We need to hold them to their words," Kennedy said.

… The opioid epidemic was a key issue in several 2016 congressional races. Advocates are hoping to keep the momentum going into the next election cycle.

THIS IS MONDAY PULSE — Where we were reminded, yet again, that we live in two Americas when it comes to health care and the ACA. According to a WaPo/ABC News poll posted Sunday, 64 percent of Republicans think Trump is trying to make the federal health law "work as well as it can," while 80 percent of Democrats say that the president is "trying to make it fail." And overall, 59 percent of Republicans think the president has done a "good" or "excellent" job improving the health system.

Which America do you reside in? Feel free to share the view. Tips to [email protected] or @ddiamond on Twitter.

With help from Rachana Pradhan (@RachanaDixit) and Renuka Rayasam (@RenuRayasam).

OHIO: WHY A LIBERAL ACTIVIST IS TEAMING WITH GOP STRATEGISTS ON DRUG PRICES — Voters in the Buckeye State on Tuesday will decide the most expensive ballot referendum that Ohio has ever seen. If approved, Issue 2 would require that state agencies purchase prescription drugs at prices no higher than those paid by the VA, which typically gets the lowest prices on medicines in the country.

The effort is backed by Michael Weinstein — a progressive activist and head of the AIDS Healthcare Foundation who tried and failed to get a virtually identical measure passed in California last year. But Weinstein has a new set of allies in Ohio: seasoned Republican operatives. And the unusual bedfellows say they're pushing on a public health issue that transcends politics and has prompted bipartisan frustration, POLITICO's Sarah Karlin-Smith writes. More for Pros.

HHS launches $10 million teen pregnancy prevention effort. The agency on Friday said it's starting a new initiative, through a partnership with Mathematica Policy Research and RTI International, to try and reduce teen pregnancies and sexually transmitted diseases.

But the timing is notable, Pro's Paul Demko notes: The Trump administration cut off more than $200 million for teen pregnancy prevention grants earlier this year. More for Pros.

Why HHS says it canceled $200 million in teen pregnancy prevention grants: The investment didn't pay off. "The very weak evidence of positive impact of these programs stands in stark contrast to the promised results, jeopardizing the youth who were served, while also proving to be a poor use of more than $800 million in taxpayer dollars," an HHS spokesperson told Paul.

For instance, HHS said that only four of 37 programs showed "sustained and positive impacts." Meanwhile, the agency said that about three-quarters of the programs "were found to have negative or no impact on the behavior of the teens … [such as] an increased likelihood of beginning to have sex, increased likelihood of engaging in unprotected sex, and an increased likelihood of becoming pregnant."







STATE WEEK: States continue scrambling to keep CHIP afloat. With Congress failing to reauthorize the program more than 35 days ago, and the legislation to extend funding caught up in a partisan fight, states are making contingency plans to keep their programs running as they wait on Capitol Hill to approve new funding.

For instance, Arizona Gov. Doug Ducey last week outlined his backup plan to keep roughly 23,000 children covered. Minnesota and Utah also have received additional funding from CMS. More for Pros.

Connecticut: How CHIP delay is putting health centers at risk. Your PULSE correspondent spent part of his trip to New Haven last week trying to understand if and how the delay in funding CHIP is having real-world consequences. According to Suzanne Lagarde — a doctor who runs Fair Haven Community Health Center, one of the city's two federally qualified health centers — the CHIP funding fight is already messing with her financial situation.

"Fair Haven was denied a loan application several months ago, due in large part to the uncertainty of funding," Lagarde told PULSE. And "if this funding isn’t renewed... we would have to undertake major layoffs and program cuts."

Texas: Authorities release undocumented girl detained in hospital. The 10-year-old girl with cerebral palsy was released on Friday to her family, according to a statement from Rep. Joaquin Castro.

The girl, Rosa Maria Hernandez, has been at the center of a growing storm about immigration authorities stepping up enforcement actions in sensitive locations. The child was stopped on her way to a medical procedure in late October, followed to a Corpus Christi hospital, and post-discharge was placed in a shelter for unaccompanied minors in San Antonio — even though her parents and grandfather, who is a legal U.S. resident, live in Laredo. Hernandez has lived in the United States since she was three months old.

… "Moving forward, we must address the Trump Administration’s callous actions," Castro said in a statement. "The United States should not be a place where children seeking life-sustaining medical care are at risk of apprehension."

Joe Swedish reportedly leaving Anthem. Swedish is planning to step down, the Wall Street Journal reported on Friday night, to be replaced by Gail Boudreaux.

Swedish's departure would come in the wake of a failed merger between Anthem, the nation's second-largest carrier, and Cigna; the two carriers are now suing each other. Boudreaux is the previous CEO of the biggest U.S. health insurer, the insurance arm of UnitedHealthGroup.

James Mathews appointed the new executive director at MedPAC. Mathews replaced longtime executive director Mark Miller, who on Friday announced he was leaving the commission after 15 years to work for the Laura and John Arnold Foundation.

Association for Accessible Medicines staffs up. AAM is adding Brett Michelin and Ashlie Van Meter as director and senior director of its state government affairs team, respectively. Michelin previously served as a VP at the California Medical Association and a top aide in the California State Senate. Van Meter had been at Quest Diagnostics as director of state and regulatory affairs and was previously at Allergan before that.

Mark Nagy elected chairman of the National Pharmaceutical Council’s board. Nagy — vice president for global patient outcomes and real world evidence at Eli Lilly — previously was vice chair of the board. NPC's board of directors also added other members to its executive committee, including naming Rich Bagger — a Celgene executive who also worked on the Trump transition — as the new vice chair.

Republicans' tax bill would do away with the medical expense deduction — and that could wreak havoc on the financial plans of some Americans with serious medical illnesses, Washington Post's Carolyn Johnson reports. More.

UPMC, the Western Pennsylvania health system giant, says it'll spend $2 billion to build three new specialty hospitals. More.

In the NY Times, Richard Thaler writes on why so many Americans choose the wrong health plans. More.

Despite Trump's early moves to shake up the ACA, his supporter with health care concerns don't regret their vote, NPR reports. More.

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