Trump Medicaid Work Requirements
The Trump administration has published its final Medicaid work requirement rule—which will require that most Medicaid beneficiaries aged 19 to 64 prove that they work, perform community service or participate in a work program to receive benefits—unless they qualify for an exemption. The rule establishes standards and procedures that each state must implement. Beneficiaries can qualify for an exemption if they are medically frail, suffer from a disability that prevents them from working or must care for a child under age 13 or a parent with a disability. States are required to implement verification procedures to confirm that a beneficiary claiming an exemption qualifies. The work requirements to into effect beginning January 1, 2027.
We asked two professors and authors of Tax Facts with opposing political viewpoints to share their opinions about the Trump administration's final Medicaid work requirement rules.
Below is a summary of the debate that ensued between the two professors.
Their Votes:
Their Reasons:
Byrnes: These work requirements are a positive first step toward rooting out waste, abuse and fraud within the Medicaid system--waste, abuse and fraud that we all know is widespread. Able-bodied Americans who are able to work and purchase their own health insurance should be required to do so. When we impose work requirements, more Americans will move into employer-provided health coverage—meaning that we free up space within the Medicaid program for the most vulnerable members of our population who are truly unable to provide for themselves.
Bloink: The new work requirement rule is flawed on a number of fronts and, at minimum, must be modified or clarified. Everyone agrees that able-bodied Americans should be doing their best to earn a living. Unfortunately, as the rule stands, millions of legitimate Medicaid-qualified individuals may lose access to the health coverage they need. Even a temporary loss of coverage can prove devastating. This rule does not go far enough to protect our most vulnerable citizens from loss of needed medical care.
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Byrnes: The exemption for medically frail individuals is compassionate and offers a grace period--but Medicaid still must verify that claims of significant sickness and/or impairments are, in fact, true. It shouldn't be enough that someone simply suffers from a medical condition. That medical condition must actually prevent them from working for the exemption to apply--otherwise, the individual should be at work. After the grace period, it's not too much to require that those claiming government benefits prove that they actually qualify for those benefits.
Bloink: The carveout from the work restrictions for medically frail individuals is inadequate at best. According to CMS, individuals who suffer from medical conditions that significantly impair their ability to satisfy the work requirements are exempt from those restrictions—if they can prove it. After a brief grace period, millions of Americans who suffer from severe and debilitating conditions will essentially have to dig up evidence to satisfy the government. For many Americans who suffer from severe medical conditions, that can be next to impossible--meaning already-overworked healthcare providers will be forced to shift through the paperwork and determine who is able to work and who is not.
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Byrnes: The Medicaid system is designed to protect the most vulnerable Americans who are unable to provide for themselves—the program is not designed to be a broadly available government handout that should be given to capable adults. The system has been abused for far too long. These new work restrictions are the key to weeding out the abuse.
Bloink: The newly created system also creates an administrative nightmare. Once these so-called verification procedures are put into place (at the state level), Medicaid itself will need time to evaluate the "evidence" that can be used to prove that critically ill taxpayers are unable to work. We have to recognize that their care simply won't wait. The system is flawed and we can do better to protect legitimately qualified Medicaid beneficiaries.