The Centers for Medicare & Medicaid Services (CMS) announced in guidance today that they would allow work requirements in Medicaid through 1115 waivers, taking the program in an unprecedented and deeply troubling new direction. Work requirements violate the goals of Medicaid, impose costly administrative burdens on states and beneficiaries, and undermine people’s health. While several states previously proposed work requirements in their 1115 waivers, HHS had always rejected them out of the belief they do not promote the objectives of Medicaid.
Work requirements are a solution in search of a problem
The majority of Medicaid enrollees who are able to work, do so. Recent evidence confirms that almost 6 in 10 nonelderly, non-disabled Medicaid enrollees are working, while almost 8 in 10 are in working families. And of those who aren’t working, many are going to school to invest in their futures, or are at home taking care of young children or sick family members.
Medicaid already helps individuals work
Not only are most Medicaid enrollees in working households but Medicaid already helps enrollees gain and maintain their employment, making work requirements that cause people to lose Medicaid coverage potentially counterproductive. Healthy individuals are more likely to work, and enrollment in health coverage has been shown to be a significant factor in helping individuals find jobs. For example, after Ohio expanded Medicaid, over 75 percent of enrollees looking for work stated having health coverage made it easier for them to search for employment because it helped them receive treatment for chronic conditions that previously hindered their ability to work or look for work.
Work requirements may in fact reduce someone’s ability to work by steadily putting health coverage out of reach for those who are out of work, causing health problems to arise or worsen. In the letter released today, CMS makes the case for work requirements by referencing Medicaid’s history of supporting individuals with work, such as the Medicaid Buy-In program that allows individuals with disabilities to maintain Medicaid while working. However, this logic could not be more twisted. Helping individuals work by allowing them to keep their Medicaid coverage as they earn higher incomes is the exact opposite of what work requirements will accomplish, which is taking health coverage away from individuals at the times when they aren’t working.
Work requirements will impose administrative burdens and increase costs on states and beneficiaries
Tracking and verifying whether Medicaid beneficiaries are working will require upfront investments from state Medicaid programs to set up the processes, technological infrastructure, staffing and other elements needed, and add significant ongoing administrative costs to states’ budgets. Moreover, enrollees will also have the increased administrative burden of needing to submit verifying documentation to prove they’re either meeting the work requirement or are eligible for an exemption. These paperwork requirements are unjust barriers to place between these individuals and their care.
At the end of the day, work requirements don’t promote work – they merely take health coverage away from low-income people. After spending the last year trying to take health care away through multiple attempts to repeal the Affordable Care Act and cut Medicaid, the Trump administration has now turned to state Medicaid waivers in a blatant attempt to place barriers between people and the health care they need. It’s a grave disappointment that both the Administration and CMS have taken this new direction with Medicaid.