The Trump administration moved Thursday to allow states to impose work requirements on their Medicaid programs for the first time, the latest alteration of the nation’s health care system through administrative action after Republican efforts to repeal the Affordable Care Act failed last year.
The change will allow states to craft programs that would require Medicaid recipients to prove they are working, training for a job, or volunteering in their communities, according to guidance issued by the Centers for Medicare and Medicaid Services.
Critics say the rules could mean more Americans are left without health insurance. But administration officials argue that the work requirements will strengthen the program and improve health outcomes by encouraging Americans to train for and seek out jobs.
“In a time of heated debate and division, helping Americans at or near the poverty line improve their lives and no longer need public assistance should be a cause that unites us all,” Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said Wednesday in a conference call previewing the move. She said the federal government is expected to begin approving state plans for work requirements in “short order.”
The policy shift is a significant departure from the Obama administration, which denied state efforts to impose work requirements in order to boost enrollment rolls. Under the Affordable Care Act, states were permitted to expand their Medicaid programs for low-income individuals at or near the poverty line, providing health insurance to those who would struggle to afford coverage even with tax subsidies provided under the law.
But Trump administration officials said states would only be allowed to impose the requirements on able-bodied and working-age Americans. Those deemed “medically frail” and pregnant women will be exempted, and states must prove they are not inappropriately denying coverage to those with disabilities. The administration is also asking states to provide exceptions for those with substance addictions, and programs may allow time spent in treatment to count toward work requirements.
The changes are an opening salvo in the administration’s push this year to overhaul federal safety net programs, with the White House asking departments and agencies across the government to review eligibility for low-income assistance programs. The White House and House Speaker Paul Ryan had hoped to introduce sweeping legislation to overhaul the nation’s welfare programs, though Trump over the weekend acknowledged the long odds such an effort would face with Republicans clinging to just a two-seat advantage in the Senate.
“It’s a subject that’s very dear to our heart,” Trump told reporters Sunday at Camp David. “We’ll try and do something in a bipartisan way, otherwise we’ll be holding it for a little bit later.”
Ten states — Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin — have proposed adding requirements for work or community engagement, according to CMS. Ohio has previously proposed a similar requirement, which was rejected by the Obama administration.
About 40% of nonelderly, non-disabled adults who have Medicaid coverage aren’t working, according to an analysis from the Kaiser Family Foundation. But many of them are either in school or staying home to care for a family member, while about a third are too sick to work. Just 6% say they want to work but can’t find a job.
CMS declined to say how many people could be potentially impacted by the work requirements, saying it would depend how states designed the programs.