Among adult Medicaid recipients aged 18 to 64, 60 percent already have jobs, according to the Kaiser Family Foundation health policy research group. Most adult Medicaid recipients who do not work reported major impediments as the reason, according to Kaiser.

The Centers for Medicare and Medicaid Services issued policy guidance on Thursday allowing states to design and propose test programs with such requirements.

Kentucky, along with 30 other states, expanded Medicaid to those earning up to 138 percent of the federal poverty level under the Affordable Care Act, former Democratic President Barack Obama’s signature domestic policy achievement commonly called Obamacare.

More than 400,000 Kentucky residents gained health insurance through the program, the highest growth rate of Medicaid coverage of any state.

WASHINGTON () – Kentucky on Friday became the first U.S. state to require that Medicaid recipients work or get jobs training, after gaining federal approval for the fundamental change to the 50-year-old health insurance program for the poor.

“Kentucky will now lead on this issue,” Governor Matt Bevin said at a news conference on Friday. “They want the dignity associated with being able to earn and have engagement in the very things they’re receiving,” he said of Medicaid recipients.

Reporting by Yasmeen Abutaleb,; Editing by Richard Chang and Peter Cooney

Bevin has said the program had become financially unsustainable under Obamacare, although the federal government covers the majority of its cost. The waiver is projected to reduce the number of people on Medicaid by nearly 86,000 within five years, saving more than $330 million.

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