policy of work requirements

 policy of work requirements

According to the policy of work requirements, also referred to as community engagement, the clients that would not be required to work to receive Medicare benefits include the elderly, pregnant women, and individuals with disabilities.

According to many groups, the concept of work requirements may be detrimental to the health and wellness of some of the most vulnerable clients for the following reasons. First, community engagement programs go against the primary objective of the Affordable Care Act and Medicaid of promoting health coverage and access. In June 2018, a federal district court invalidated the initial approval of Kentucky’s waiver by the CMS because the Secretary failed to consider the impact of the waiver on the primary objective of Medicaid of providing affordable health coverage (Musumeci, 2018). Second, evidence shows that the work engagement program does not meet their objectives of promoting better mental, physical, and emotional health in line with Medicaid program objective but rather adversely affect health (CMS, 2018). Reports from Arkansas prove that work requirements have led to working individuals losing coverage due to reporting difficulties (Krisberg, 2019). Third, although the programs are meant to help individuals and families rise out of poverty and attain independence, instead, they push them deep into poverty by making them denying then insurance hence making them pay for their medical expenses (CMS, 2018). Fourth, Medicaid requirements do not lead to an increase in employment or improve health outcomes, which is contrary to what the Trump administration claims. Work requirements do not accurately identify individuals who can work but are not able to work for reasons beyond their control, and they do not assess the needs of these individuals or provide them with supports.

The American Health Care Act (AHCA) can help manage the challenge of increasing costs for low-income clients. The Act proposes to convert guaranteed Medicare matching funds to a per capita cap that limits the amount of federal Medicaid funding that states would receive per enrollee (Wiener et al., 2017). Also, AHCA provides states with the option of receiving a block grant that would not vary on enrollment for a specific population.

In a letter addressed to my state representative, as a professional nurse, I would beg to differ with the proposal to include work requirements waivers. The letter would convey the following message

Medicaid 1115 waivers result in loss of coverage for vulnerable populations. The Trump Administration has approved requests from several states on Medicaid Section 1115 waivers. The unintended consequence that has resulted from these requests is taking Medicaid coverage away from people who do not meet work requirements. Aspects of these policies, such as work-related activities or who must report work, how they report, who is exempt, the number of hours required for compliance, and the penalty for not reporting, will determine how many and how quickly enrollees lose coverage. What is clear is that all these policies have the consequence of taking coverage away from people who are already working or who should be exempt from the requirement based on reasons such as a disability or chronic illness.

Changes in Work Environment

The workforce ecosystem model is a system that guides nurses on how to create healthier work environments. The model has elements that provide powerful tools and evidence-based solutions to navigate workplace challenges, maximize career benefits, and optimize patient outcomes (ANA, 2020). The elements include staffing, workflow design, organizational factors, physical environment, and personal/social factors.

Using the components of the workforce model, the following changes or actions will alter the working environment and ensure full nurse staffing

Staffing­- in terms of professional skills required, the new Director would ensure that nurses hired have experience working with minority or vulnerable populations in a move to improve the quality of care delivered.

Workflow design- the Director would implement a rotation program where each nurse gets to familiarize themselves with the entire nature and scope of their work, providing services to this specific community.

Personal/social factors- the Director would roll out training programs on cultural sensitivity and the nursing Code of Ethics to ensure that nurses understand they have a duty to provide the best possible outcome for patients without prejudice.

Physical environment– the Director would convene a meeting with the maintenance staff and instruct them to make all the necessary repairs to ensure that the all aspects related to the physical environment such as lights, sound systems, and aesthetics function on the optimal capacity to make the hospital setting welcoming and conducive to patients.

Organizational factors- changes in the work environment that the nurse director would implement include establishing a culture that supports shared governance and nurse autonomy. In such a culture, nurses would be involved in the decision-making process on critical issues that not only affect patients but the nursing profession as a whole. Such a culture would promote respect among healthcare professionals at all levels and would eliminate insensitive comments or stereotypical statements.

Some of the ethical issues identified in the ANA Code of Ethics that must be addressed by the workforce model include patient autonomy and duty of care. Despite their low socioeconomic status, patients in this community deserve respect and empathy from nurses as stipulated in Provision 1 of the Code of Ethics on compassion, respect, and dignity that nurses should uphold (Haddad & Geiger, 2019). Provision 3 holds that nurses have a duty of care to their patients and that they must at all times promote, advocate for, and protect the rights, health, and safety of patients.

Two types of training that would be included in the orientation program for all staff are cultural sensitivity and nursing responsibilities. Nurses need to understand that patients need to be treated with dignity, and they should avoid making insensitive comments or insensitive statements. Fellow nurses laughed at the new nurse director when she decided to stay and advised her to leave the job. The nurses seem not to understand that they have a responsibility to deliver high-quality care and improve patient outcomes.