States can require Medicaid recipients to work, Trump administration says

Ross Houston
January 14, 2018

"As our letter explains, the administration is making an about face in its efforts to overturn established [Department of Health and Human Services] policy against work requirements without public comment".

The Trump administration outlined the plan in a letter to state officials indicating the administration's willingness to grant state requests for imposing job requirements on working-age, nondisabled beneficiaries. States would first have to seek a Section 1115 waiver, a provision that allows the administration to approve experimental plans.

The historic move would be a significant change in how the government health insurance program operates and would fulfill a longtime Republican goal. Under our proposal, people who receive Medicaid and are able bodied will need to work, be training for a new career, or volunteer. "Not working is not in their best interest, not for their health or family or their poverty status, it leads them to be more likely to be poor". They fear many recipients will be unable to meet the mandate and be left uninsured.

"While work requirements are meant to promote work among those not working, coverage for those who are working could be at risk if beneficiaries face administrative obstacles in verifying their work status or documenting an exemption", KFF said. She cited studies that show a correlation between good health and having a job. No state or federal administrator can add another requirement that is not in federal law. The requirement would not apply to some participants, including pregnant women, those being treated for substance abuse, "the medically frail" and those older than 60.

These work requirements for poor people to get health insurance is just the start, Dunn claims. However, they will not be allowed to use federal Medicaid funding to finance these services. Before enforcing those requirements, states must receive a waiver from CMS. "Such programs may also, separately, be created to help individuals and families rise out of poverty and attain independence, also in furtherance of Medicaid program objectives".


Republicans have long wanted to add work requirements to the Medicaid program, which covers almost 75 million low-income children, adults, elderly and disabled Americans.

States would have the flexibility to identify activities other than employment that promote health and wellness and could include community service, caregiving or job training. It has improved low-income people's financial health, helped states fight the opioid epidemic, and improved access to care.

The Trump administration swiftly signaled that it held a different view.

The new plan sets the stage for a potentially long and contentious legal battle over the shape and objective of a health program that more than 70 million Americans now depend on. About one-fifth work in the health servicesor education fields.

Not only does it have a new Medicaid director, but the state is searching for at least one other company to help manage its privatized system, which has been coming under sharp criticism.


The work requirements "could have negative implications on many who are working or exempt from the requirements".

"For the future of our country, we need all Americans to be active participants in their communities", she said in November. "Those days are over". The Kaiser Family Foundation estimates that there are almost 25 million non-elderly adults on Medicaid who are not on disability insurance. "The work requirement will deny care to untold numbers of Americans", Public Citizen President Robert Weissman said in a statement.

Kentucky also anticipates the most drastic drop in Medicaid enrollment out of the 10 states with pending work requirement waivers, according to an analysis by the Commonwealth Fund.

Homeless people, former foster children and American Indians are among individuals who would be exempt from Arizona's proposed Medicaid work requirements, the state's application says.


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