The Trump Administration announced Thursday it would be providing opportunities for states to impose work requirements for Medicaid recipients.
Federal officials said they would support states’ efforts to require able-bodied, working-age Medicaid recipients to hold a job or engage in community service.
Medicaid is a massive government health insurance program that currently covers more than 70 million Americans. Along with federal programs like welfare and SNAP, it is one of the primary drivers of our growing deficit.
The following states have already applied for waivers involving work requirements or community involvement for Medicaid recipients: Arkansas, Kentucky, Arizona, Indiana, Kansas, Wisconsin, New Hampshire, Maine, North Carolina, and Utah.
“Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration,” says Seema Verma, who heads the Centers for Medicare and Medicaid Services. “Those days are over.”
Under the Obama Administration, states were denied efforts to impose work requirements on Medicaid recipients. But the Affordable Care Act allowed states to expand Medicaid to provide health insurance for low-income individuals who couldn’t afford coverage even with tax subsidies. The ACA expansion added an estimated 12 million Americans to Medicaid.
The Trump Administration's new guidelines are bound to face pushback and legal challenges over concerns about people losing coverage.
“It is a very major change in Medicaid that for the first time would allow people to be cut off for not meeting a work requirement, regardless of the hardship they may suffer,” complains Judy Solomon of the Center on Budget and Policy Priorities. Others argue that Medicaid coverage is what enables some people to find work in the first place.
A Kaiser Family Foundation poll conducted in 2017 suggests up to 60% of able-bodied Medicaid recipients already have full- or part-time jobs.
“Productive work and community engagement may improve health outcomes,” says Brian Neale, director of the federal Medicaid office. In addition, researchers have found “strong evidence that unemployment is generally harmful to health.” A Gallup poll conducted in 2013 found that people without a job are more than twice as likely than people with a job to seek treatment for depression.
The debate on work requirements does not fall evenly along party lines. The Kaiser poll suggests 70% of Americans support allowing states to impose work requirements, despite the widespread lack of support for the Trump Administration’s proposed cuts to Medicaid.
The Trump Administration’s new guidelines exempt children, pregnant women, disabled people, and the elderly from work requirements. Medically frail recipients will not be denied coverage.
Among other rules, states must take into account the number of jobs available in a region and must comply with federal disability and civil rights laws. For example, people with certain disabilities will be required to work fewer hours.
Modifications will also be made for people addicted to opioids. For example, time spent in medical treatment for drug addiction/substance abuse could be counted as community engagement.
States who choose to impose work requirements must also take steps to connect recipients with job opportunities.
“This is about helping people rise out of poverty,” says Verma. "There are a lot of different ideas, and a lot of ways to go about this. We want to give states as much flexibility as possible because that's where we'll be able to evaluate what actually works best."
Editor's note: This is designed to encourage people to start working, and possibly reduce the burden on the federal deficit. Will it work? We will see.