Trump Administration Gives the Green Light for Medicaid Work Requirements


For the first time in the history of the program, the federal government will allow states to impose work requirements for access to Medicaid.

On Jan. 11, the Centers for Medicare & Medicaid Services (CMS) announced guidance for states to test “community engagement” for Medicaid recipients.

Ten states have submitted proposals for Medicaid work requirements so far. Several others are considering doing so as well.

So what could this new guidance from the Trump administration mean for the 72.5 million Americans receiving Medicaid benefits and the millions more who will need it in the future?

Here’s what we know so far.

Some states will impose work requirements for Medicaid

As a nationwide public health insurance program for low-income people, Medicaid provides coverage to one in five Americans. In recent years, many states have expanded Medicaid coverage to include more of the nonelderly population, including the working poor and adults with disabilities.

The new guidance, however, could reverse this trend by allowing states to impose work or “community engagement” requirements for Medicaid coverage. It would be up to each state to implement these measures.

Kentucky, for example, is proposing that nondisabled people between 19 and 64 must work at least 20 hours per week to qualify. They also could fulfill this requirement through volunteer work, job training, education, or caregiving.

According to the new guidance, states should permit exemptions, particularly for pregnant women, full-time students, caretakers, and adults with disabilities. It also encourages an exemption for people who are deemed “medically frail.”

However, the Kaiser Family Foundation found that the vast majority of non-Supplemental Security Income Medicaid enrollees were unemployed for those reasons. Among such enrollees, 90 percent were unemployed because they were ill or disabled, retired, taking care of their home or family, or attending school.

Although each state could design these requirements differently — and some states might not add them at all — this new approach marks the first time Medicaid would require proof of work in exchange for health coverage.

Critics say new rules will strip people of crucial benefits

Seema Verma, the administrator of CMS, has lauded the new guidance as a step forward for Medicaid and public health.

But critics suggest the move could leave many people uninsured.

In a statement for the Center for American Progress, Executive Vice President for External Affairs Winnie Stachelberg said, “Ripping away health care from people who have lost their jobs will not create a single job, raise anyone’s wages, or help anyone who is struggling to find work.”

“Instead,” she continued, “it kicks people while they’re down — taking away health care from unemployed or underemployed workers when they need it most.”

The Southern Poverty Law Center also has condemned the new Medicaid guidelines from the Trump administration as a step backward for public health.

Anyone who loses their Medicaid benefits might be hard-pressed to find an affordable alternative. Without employer-sponsored health insurance, you could enroll in a plan through during open enrollment or “special enrollment.”

According to the U.S. Department of Health and Human Services, about 78 percent of enrollees paid less than $100 per month for their plans in 2016. But that amount could be unaffordable without a regular income.

Besides looking into alternative health care plans, another way to protect yourself is to stay on top of state requirements. If you’re not able to meet the work requirement, you could potentially qualify through other activities, such as volunteering.

Although the work requirements might be flexible, some Americans could have trouble showing they’re exempt if, for example, they can’t show a diagnosed disability. Extra red tape also could prevent some Americans from applying for Medicaid in the first place.

If you fall into a murky gray area, hold on to any documentation that could support your eligibility or prove you’re exempt from new state requirements.

Stay informed about upcoming changes to Medicaid coverage

In its May 2017 budget proposal, the Trump administration stated its intention to allow states to manage how they administer Medicaid programs.

Yesterday’s guidance from Verma and the CMS fulfilled that promise. Many people expect state proposals to be approved within a matter of days.

If you rely on Medicaid for health care benefits — or care for someone who does — stay informed about your state’s eligibility requirements so you can protect your benefits.

And if you’d like to take action, call the U.S. Capitol switchboard at (202) 224-3121 and ask to speak with your state representative.

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