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CMS Administrator Seema Verma. Photo: NICHOLAS KAMM/AFP/Getty Images

The Trump administration this morning took the first formal steps toward adding work requirements to Medicaid — likely one of the biggest changes this administration will make to the health care system.

Why it matters: Work requirements are a way to pare back Medicaid coverage, allowing states to remove some able-bodied adults from their rolls. In the face of congressional Republicans’ inability to pass a larger health care bill, these administrative actions are among conservatives’ best chances to pull Medicaid in a more conservative direction, after the Affordable Care Act dramatically expanded the program.

The big picture: The Centers for Medicare & Medicaid Services says in a new guidance document that it “will support state efforts to test incentives that make participation in work or other community engagement a requirement for continued Medicaid eligibility.”

  • This will all run through an existing waiver process that states frequently use to help tailor their individual Medicaid programs. CMS will still need to approve those waivers, so not every proposed work requirement will necessarily happen — but the administration wants to say “yes” as much as it can.
  • Using Medicaid to cover able-bodied adults “does not make sense,” CMS Administrator Seema Verma said in a recent speech previewing this policy.
  • That’s a stark change from the Obama administration, which firmly rejected states’ requests for Medicaid work requirements.

The details: Work requirements will be targeted at adults who are not disabled.

  • It’s not just work: States can seek to impose a variety of “community engagement” requirements, CMS says, including work as well as job training or certain volunteer efforts. Work, though, is the one red states are most interested in.
  • Many people are not technically enrolled in Medicaid due to a disability, but are in fact disabled. CMS says states will still have to comply with federal civil rights laws to ensure that disabled people are not wrongfully denied coverage.

Go deeper

USAID chief tests positive for coronavirus

An Air Force cargo jet delivers USAID supplies to Russia earlier this year. Photo: Mikhail Metzel/TASS via Getty Images

The acting administrator of the United States Agency for International Development informed senior staff Wednesday he has tested positive for coronavirus, two sources familiar with the call tell Axios.

Why it matters: John Barsa, who staffers say rarely wears a mask in their office, is the latest in a series of senior administration officials to contract the virus. His positive diagnosis comes amid broader turmoil at the agency following the election.

Bryan Walsh, author of Future
4 hours ago - Health

COVID-19 shows a bright future for vaccines

Illustration: Annelise Capossela/Axios

Promising results from COVID-19 vaccine trials offer hope not just that the pandemic could be ended sooner than expected, but that medicine itself may have a powerful new weapon.

Why it matters: Vaccines are, in the words of one expert, "the single most life-saving innovation ever," but progress had slowed in recent years. New gene-based technology that sped the arrival of the COVID vaccine will boost the overall field, and could even extend to mass killers like cancer.

6 hours ago - Health

Beware a Thanksgiving mirage

Illustration: Sarah Grillo/Axios

Don't be surprised if COVID metrics plunge over the next few days, only to spike next week.

Why it matters: The COVID Tracking Project warns of a "double-weekend pattern" on Thanksgiving — where the usual weekend backlog of data is tacked on to a holiday.

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