New rules could kick sick people off Medicaid

**SPEAKER_1** (0:00)
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WBUR Podcasts, Boston.

**Rachel Klein** (0:20)
Now, they're going to have to go in and figure out who has a serious condition and who is sick enough from that condition that they can't meet this work requirement.

**Chris Bentley** (0:31)
The Trump administration is making it harder to qualify for Medicaid.
It's Tuesday, June 9th, and this is Here and Now Anytime from NPR and WBUR. I'm Chris Bentley. Today on the show, a veterinary entomologist tells us just how much we should worry about the reemergence of a cattle-eating parasite in Texas.

**Edwin Burgess** (1:02)
The New World screwworm is unique in that its larvae develop in the living tissue of warm-blooded animals.

**Chris Bentley** (1:10)
Also, a college football quarterback admitted to gambling at least $90,000 on sports, including his own team. But a court ruled he can keep playing.

**Amanda Christovich** (1:21)
This ruling could be cited in future cases for other athletes who engage in sports betting activity. However, before, you know, everybody panics, it could be cited, but it doesn't immediately open the floodgates across the country.

**Chris Bentley** (1:35)
Before we get to that story, though, Congress made big changes to Medicaid last year, and we're starting to see what those changes mean for poor, sick, and disabled people who get their health insurance through the government. Rules revised by the Trump administration this month add new work requirements, and a whole lot of new paperwork for people seeking coverage to prove they're eligible.
That's because starting in January, people aged 19 to 64 will have to either prove they're too sick to work, or else prove they worked 80 hours in the prior month, or were in school, or volunteered for 80 hours, to keep their health insurance.
The nonpartisan Congressional Budget Office estimates the changes could effectively kick 5 million Americans off Medicaid. Medicaid is a government-run health insurance plan administered jointly by the federal government and the states. So state workers are scrambling to figure out who will be affected by the new rules. That includes Colorado's state Medicaid director Adela Flores-Brennan. She told Scott Tong she's working hard to keep people from losing their coverage.

**Adela Flores-Brennan** (2:43)
Yeah, so our North Star at Colorado Medicaid is to really mitigate and minimize the loss of coverage because it's really important to us that our members remain covered.
That being said, these requirements are going to be confusing. I do imagine that unfortunately people will get caught up either in the paperwork requirements or not being able to meet the work requirements themselves to be able to stay enrolled.

**Scott Tong** (3:20)
And speaking of big change, does Colorado have the resources, the staff, the computer systems, the know-how to put in place this huge change?

**Adela Flores-Brennan** (3:32)
I think we have the know-how and we are working really, really hard to understand all of the requirements and build them into all of our systems. Now, I'm sure you're aware that we had some new regulations issued earlier this month and we are still working to understand the changes to how we were proceeding before those regulations came out.
We're going to have to train up all of our eligibility workers in 64 different counties to be able to handle all of these new requirements.

**Scott Tong** (4:07)
Well, there's one specific from these new work rules that's attracting a lot of attention. Here's my understanding of it. If you have a disease like cancer or HIV, the disease itself is not enough to stay on Medicaid. You have to show your condition significantly impairs your ability to work. In other words, you have to show you're too sick to work. And I want to play a cut of sound from Rachel Klein. She's Deputy Executive Director of the AIDS Institute.

**Rachel Klein** (4:34)
I think this is really just an impossible task for states.
You know, they've already been trying to set up these systems with the understanding that they would have to figure out who has a serious or complex medical condition. And now they're going to have to go in and figure out who has a serious condition and who is sick enough from that condition that they can't meet this work requirement.

**Scott Tong** (5:00)
And so the question for you is, could she be right?

**Adela Flores-Brennan** (5:04)
I believe she could be right. This is a direction that we were not proceeding in. We were operating under the understanding that by having a diagnosis of a certain kind, that would be sufficient to demonstrate medical frailty.