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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

Scoop: Over 200 papers quietly sue Big Tech

Illustration: Allie Carl/Axios

Newspapers all over the country have been quietly filing lawsuits against Google and Facebook for the past year, alleging the two firms monopolized the digital ad market for revenue that would otherwise go to local news. 

Why it matters: What started as a small-town effort to take a stand against Big Tech has turned into a national movement, with over 200 newspapers involved across dozens of states.

Axios-Ipsos poll: Shrugging off Omicron

Expand chart
Data: Axios/Ipsos poll; Note: The last question only includes 589 employed respondents; Chart: Kavya Beheraj/Axios

Most Americans aren't willing to make big changes in their behavior to minimize the risk from the Omicron variant, like avoiding indoor restaurant dining or cancelling their holiday travel plans, according to a new Axios-Ipsos poll.

The big picture: The poll found support for some broader public responses, including one — travel bans aimed at people from other countries — that was widely supported by people across the political spectrum. But it found that Americans are only willing to do so much on their own.

Rohingya refugees sue Facebook over Myanmar hate speech

Internally displaced Rohingya peoples at a market area in the Baw Du Pha IDP Camp in Sittwe in Myanmar's western Rakhine state. Photo: STR/AFP via Getty Images

Rohingya refugees accused Facebook in a $150 million lawsuit filed Monday of amplifying hate speech against the persecuted minority Muslims in Myanmar via algorithms and failing to take down inflammatory posts.

Why it matters: Thousands of Rohingya Muslims have been killed in Myanmar in what the United Nations deemed a genocidal campaign. Tens of thousands of others have been displaced, notably following a massacre by Myanmar's military in 2017.

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