AMA adopts policy calling for exemptions for Medicaid work requirements

CHICAGO - Physicians and medical students at the Annual Meeting of the American Medical Association (AMA) House of Delegates today adopted new policy urging federal and state policymakers to ensure that Medicaid work requirements are implemented in a manner that protects patients with serious medical needs while minimizing administrative burdens on patients and physicians.

The policy was approved as states prepare to implement work and community-engagement requirements under recently enacted federal regulations.

The House of Delegates directed the AMA to work with the Centers for Medicare & Medicaid Services (CMS) and state Medicaid agencies to establish exemptions from Medicaid work rules that are clinically grounded and protect individuals who are medically frail while preserving state flexibility to build locally tailored exemptions.

Also, the AMA will advocate for automatic exemptions for patients and caregivers of patients with complex medical conditions.

"The AMA believes that patients with serious illnesses and complex medical conditions should not face unnecessary barriers to maintaining health coverage. Neither should their caregivers," said Melissa J. Garretson, MD, a member of the AMA Board of Trustees. "Medical frailty exemptions must reflect clinical realities and protect vulnerable patients while avoiding burdensome administrative requirements that can interfere with care."

The AMA will urge states and the federal government to define "medical frailty" and "complex medical conditions" to include life threatening or complex chronic medical conditions, or other conditions that result in functional impairments or require an ongoing need for medical care. States should have the authority to expand these protections to additional populations. The automatic exemption from community engagement and work requirements for patients and primary caregivers is designed to avoid burdens on both patients and physicians, minimize improper disenrollments or denials of eligible patients, and ensure continuity of care.

The resolution passed just after CMS issued a regulation on Medicaid work requirements. The AMA believes the regulation's narrow definition of medical frailty will result in people with serious illnesses being denied exemptions. The red tape generated by the rule's administrative requirements also will significantly burden patients and physicians, contributing to coverage loss.

Physician leaders have emphasized that implementation must be broad enough to capture the full spectrum of serious illnesses and disabilities that can limit an individual's ability to comply with work requirements.

"Patients undergoing cancer treatment, living with advanced heart disease, managing severe mental illness, recovering from major medical events, or coping with other complex conditions should not risk losing coverage because of narrow interpretations of medical frailty or excessive paperwork requirements," Dr. Garretson said.