Today's Health Care Issues by Robert B. Hackey

Author:Robert B. Hackey
Language: eng
Format: epub
Publisher: ABC-CLIO
Published: 2021-07-23T00:00:00+00:00

Medicaid Work Requirements

At a Glance

Medicaid is the nation’s major public health insurance program for low-income and disabled individuals. Established in 1965, Medicaid is now the nation’s largest insurer, providing coverage for more than 27 million nondisabled adults in 2020. Beginning in 2018, 16 states sought waivers to establish work requirements for nondisabled adults insured by Medicaid. This flurry of activity reflected new guidance from the Trump administration that encouraged states to explore the option of instituting “work and community engagement” requirements as a condition of program participation. However, the new work requirement applied only to “able-bodied” adults and included exemptions for the elderly, children, pregnant women, and the disabled. Proponents argued the new requirements would improve enrollees’ health and well-being by helping “individuals and families rise out of poverty and attain independence . . . in furtherance of Medicaid program objectives” (Sarlin 2018). As of December 2019, the Trump administration had approved 10 state waiver applications to establish work requirements for Medicaid beneficiaries (Campo-Flores 2019). Arkansas was the first state to implement work requirements in 2018.

Opponents of the new work requirements mounted legal challenges in federal court; in 2019, District Court Judge James Boasberg set aside the Trump administration’s approved waivers in Arkansas, Kentucky, and New Hampshire. In February 2020, a federal appellate court unanimously rejected the Trump administration’s appeal (Pradhan and Luthi 2020). As a result, the future of work requirements for Medicaid remains uncertain. In addition, two states that received approval to institute work requirements, Maine and Kentucky, ended their participation after electing Democratic governors. Utah, which implemented its community engagement program for Medicaid beneficiaries in January 2020, suspended its work and reporting requirements in April 2020 in response to the COVID-19 pandemic (Utah Department of Health 2020).

Democrats favor expanding, not restricting, access to Medicaid coverage. Thus, they regard work requirements as unlawful and punitive because they undermine Medicaid’s principal policy objective of increasing access to health care. For Democrats, increased Medicaid enrollment provides tangible proof of the program’s success in reaching its target population. In this view, expanding Medicaid enrollment supports work by improving individuals’ access to preventative services and primary care. Healthier beneficiaries, in short, will be more productive and better able to support themselves. Democrats frequently attack work requirements as thinly veiled efforts to reduce the number of individuals eligible for Medicaid.

Republicans stress the importance of earned success—or dignity through hard work. Republicans contend that generous eligibility for Medicaid undermines individuals’ work ethic and fosters dependency, not self-sufficiency. In this view, the success of social welfare programs is not measured by how many people enroll in public programs but rather by how few people actually need government assistance. Thus, Republicans regard rising Medicaid enrollment as evidence of steadily worsening policy problem, not a policy success. Republicans believe that work requirements will cut costs, encourage self-sufficiency, and foster a sense of dignity among beneficiaries. Finally, Republicans argue state Medicaid programs should reflect local preferences and circumstances.

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