Feds encourage work requirement in Medicaid for able-bodied adults

Andrew Harnik | AP | BDN

"Work requirements offer opportunities to lift individuals out of poverty, empower them with the dignity of work and self-reliability while also allowing states to control the costs of their Medicaid programs", he said in a statement released soon after the CMS announcement. But the expansion under President Barack Obama led to millions of non-disabled low income adults added to the program.

Kentucky has become the first state to win approval from the Trump administration requiring many of its Medicaid recipients to work to receive coverage. Under state work requirements, people have to verify their work status or their qualification for an exemption, according to, associate director of Kaiser Family Foundation's Program on Medicaid & the Uninsured. Almost 60 percent work either full time or part time, mainly for employers that don't offer health insurance.

Medicaid is already expected to be a hot topic at the Statehouse this year, as the New Hampshire Health Protection Program, or Medicaid expansion, is set to be renewed.

The red tape associated with work requirements also adds a new burden on the agencies that administer Medicaid benefits, Musumeci noted.

Still, critics fear a work requirement could have a chilling effect on people signing up for Medicaid or make it harder for people to get coverage.

Greg Moore, state director with Americans for Prosperity, points out that the state budget requires the state to enact work requirements for the Medicaid expansion population by April 30, or notify expansion recipients that the program will terminate on December 31.

People who gained coverage through Medicaid expansion (who can make up to $16,670 for a one-person family) will have to pay a copay or premium.

The new rule, to be rolled out in July, would mandate able-bodied Kentuckians on Medicaid to work or volunteer 20 hours per week.


Maine Voters Chose Medicaid Expansion.

Education and Workforce Development Cabinet Secretary Hal Heiner says the program will help citizens find a faster path to better health, but Rep. John Yarmuth (D-03) called it irresponsible.

Kentucky is one of 10 states that have applied to CMS to enact a work requirement. Also off the hook are the more than 10 million enrollees who have a disability.

"It places their insurance coverage at existential risk, despite the fact that there is no evidence that suggests that work requirements produce major changes in employment or income, and despite the fact that the health risks that these kinds of requirements potentially create vastly outweigh whatever gains are going to be achieved", she said. According to government statistics, 60 percent of non-disabled, working-age adults having a job, while almost 80 percent live with families that have at least one member in the labor force.

The stated objective of the new guidance is to encourage work, which the Trump administration argues is ultimately good for people's health. We know from experience with other benefit programs that eligible people already working or deemed exempt from working are likely to lose coverage simply because of added paperwork and enrollment hurdles - not because they are ineligible.

The elderly, disabled, children and pregnant women would be excluded from the requirements.

But Sara Rosenbaum, a law professor at the Milken Institute School of Public Health at George Washington University, said the letter doesn't actually bar states from kicking people with substance abuse problems off their insurance.

"If CHIP funding runs out - and that seems to be what is happening as of this month in many states - that will lead children to be dropped from the program and will cause many pediatricians to rethink whether to participate in CHIP, since they will not have assurance that the bills will continue to get paid", Saloner, who wasn't involved in the study, said by email.

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