Trump Administration Will Allow States to Impose Medicaid Work Requirements

This story has been updated to reflect that Kentucky is the first state approved for the Medicaid work requirement.

On Thursday, the Trump administration announced new policy guidance allowing states to require people on Medicaid work or volunteer to maintain eligibility. The policy is in response to work requirement proposals sent to the Centers for Medicare and Medicaid Services (CMS) by 10 states.

The work requirement is aimed at “able-bodied” adults, and excludes those on Medicaid for disability, the elderly, children and pregnant women. Those who are deemed “medically frail” or have an acute condition that prevents them from working are also exempt.

The guidelines outline special advisements for states considering work requirements. These include exemptions for those who live in areas with high rates of unemployment as well as excluding those who are caregivers for young children and older adults.

States are still required to provide healthcare coverage and reasonable accommodations pursuant to civil law to people with disabilities.

Despite the policy guidance, not everyone believes states will honor the disability and illness exemptions. Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities, took to Twitter to voice her concerns about the new requirement.

These people including people with cancer, mental illness and substance use disorders, will be subject to the work requirement and have to prove they are exempt with a doctor's letter or other proof. Many won't know to do that and some won't be able to get the paperwork.

— Judy Solomon (@JudyCBPP) January 11, 2018

Rebecca Vallas, managing director of the Poverty to Prosperity Program at the American Center for Progress, detailed caveats to the guidelines that could harm people with disabilities.

The guidance also admits that lots of folks may need “supportive services” to work or find work–job search help, disability supports, transportation etc.

But it then makes clear states CAN’T USE FEDERAL MEDICAID FUNDS to pay for these services. 14/ pic.twitter.com/UCCEjDCwiS

— Rebecca Vallas (@rebeccavallas) January 11, 2018

According to the Kaiser Family Foundation, 60 percent of adults on Medicaid were already working in 2016. Of those who were unemployed and did not qualify for Social Security disability, 36 percent cited a disability or illness as a reason, 15 percent said they were in school and 30 percent were caregivers. Only 6 percent weren’t working because they couldn’t find a job.

On Friday, Kentucky became the first state to receive federal approval to instate a work requirement. The change will begin in July and will effect around 350,000 residents, though about half of them already work or satisfy the requirement in some other way.

Work requirements have been used in other government welfare programs such as with the Supplemental Nutritional Assistance Program (SNAP), formerly known as food stamps. In areas where work requirements could have been waived due to lack of job opportunities, states decided not to waive them, causing strain on people who needed benefits but couldn’t find a job. Something similar could happen with Medicaid work requirements, experts warn, except instead of losing food benefits, people would lose health insurance.

According to the Center on Budget and Policy Priorities, thousands of people could lose health coverage while waiting for their waiver applications to go through. This happened in Ohio in 2014, causing many people to lose Temporary Assistance for Needy Families (TANF) and SNAP benefits because of paperwork issues.