Since its inception in 1965, Medicaid has acted as a lifesaver for the millions of low-income Americans who struggle with inadequate finances. It not only helps infants and pregnant women but also takes care of elderly individuals and people with disabilities, forming some of the most vulnerable populations in the country.
For Medicaid, it’s mandatory to be working to qualify for the benefits. Supporters say that it promotes self-sufficiency and lowers dependency. Others, however, believe that this could cause a tremendous loss in coverage among those most in need, who are already facing barriers to employment.
This blog will cover the medicaid work requirement, focusing on its history.
Who Qualifies for Medicaid?
Medicaid Eligibility varies by state but generally includes the following groups:
- Low-income individuals and Families: Income limits vary, but most states cover low-income adults, children, and parents.
- Senior Aged 65+: People who also qualify for Supplemental Security Income (SSI) or need long-term care.
- People with Disabilities: Individuals who meet specific disability criteria and have limited income and resources.
- Pregnant Women: Many states provide coverage during pregnancy and postpartum.
- Children: Medicaid and the Children’s Health Insurance Program (CHIP) cover millions of eligible children from low-income families.
Origins of Policy
Social Security Act, Section 1115
Medicaid provides partnerships with states to develop their own work requirement policies aligned with the framework policy. There is slightly more flexibility with the area modification of region procurement procedures per Section 1115.
The Secretary of Health and Human Services is allowed under section 1115 of the Social Security Act to sanction experimental, pilot, or demonstration projects that further the goals of the Medicaid work requirement program and CHIP. These waivers permit states to have a try at new ways of providing and paying for health care services.
Trump Era
As part of the “personal responsibility” agenda of the Trump administration aimed at increasing self-sufficiency and reducing government spending on healthcare, the Centers for Medicare & Medicaid Services (CMS) in 2018 actively sought to implement work requirements within Medicaid at the state level.
From 2018 to 2020, at least thirteen states had work requirement waivers approved by CMS, including:
- Arkansas
- Kentucky
- Wisconsin
- Arizona
- Indiana
- New Hampshire
Arkansas was the only state to attempt full execution of the policy, but the courts shut that down.
Implementation and Impact: Lessons from Arkansas
Arkansas put forth its medicaid work requirement in June 2018. A mere seven months later, over 18,000 people lost Medicaid coverage because they did not meet reporting requirements.
It is important to highlight that these individuals were not failing to work, but they failed to understand and follow the online-only reporting system, which many found confusing and inaccessible. Most were completely uninformed of the policy.
This raised legal concerns, which were swiftly acted on as unconstitutionally mandated reporting requirements, cited especially with federal judges. This prompted an end to the Arkansas policy in 2019, leading to other courts blocking policies in other states.
Reasons Why Supporters Advocate for Work Requirements
As coverage gaps persist in Medicaid and work requirements, some policymakers remain stubbornly fixated on medicaid work requirements. Supporters contend that such policies:
Foster Own Efforts and Personal Responsibility
It is believed that increased volunteer opportunities or paid work positions will create a greater level of self-reliance and less public dependence over time.
Increases Better Health Outcomes
Some of the experts believe that having some meaningful work or some activity in every individual’s life improves their general standard and hence better health outcomes, though data substantiating the argument is sorely lacking.
Maintain State Budgets
Supporters argue that the alleviation of enrollees through medicaid work requirements by state would lessen the financial strain on state Medicaid programs.
Integrate Medicaid with Other Programs
Some federal benefit schemes have incorporated features and requirements, like Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF). Concerning this, proponents argue that Medicaid for Carolina should follow suit.
Arguments Against: Lack of Criticism of Medicaid Work Requirement
Public health professionals, legal scholars, and patient advocacy groups have voiced profound concerns regarding the possible negative impact that work requirements can bring. Some of the arguments include:
Coverage Losses are Disproportionate
Reports suggest that tens of thousands may stand to lose coverage, not owing to refusal of work, but due to the complicated nature of the reporting procedure, lack of access to the internet, lack of transport, or easily losing stability in employment.
Little to No Employment Opportunities
A study conducted by the New England Journal of Medicine highlighted that work requirements have not boosted employment rates in Arkansas since 2019. Most people on Medicaid who are capable of working are already working in the lower rungs of low-paying jobs, which lack substantial health insurance benefits.
Risk for Underprotected Groups
The individuals, along with the mentally challenged or physically challenged ones, the homeless, and family caretakers, are often exempt from the requirements. However, they can still end up in the red tape and pop the inclusion bubble of losing coverage.
Difficult and Expensive Administration
States can end up spending millions of dollars installing monitoring systems, hiring, setting up appeal processes for medicaid work requirement, and tracking employees, which may set states back further than the savings from enrollment reductions.
Legal and Political Terrain
Court Issues
Almost all states that tried imposing work requirements for Medicaid have had the policy suspended in courts as of 2020. Judges ruled that CMS did not justify how imposing such demands met the Medicaid contract policy.
Position of the Biden Administration
Biden’s administration, in the same way, has also stated concern over state flexibility regarding work mandates orders by withdrawing consent to state waivers concerning medicaid work requirements within the state boundaries.
What to Expect of a New Wave Come 2025?
Indiana is among the few Republican states with a proposal to expand Medicaid eligibility 2025 and additionally integrate it into a workfare-based economy with changes to food stamp eligibility. Such proposals are expected to emerge from the works of the primary sponsoring Indiana Marion University.
Nebraska recently set a dozen new policies around the scope, deciding the scope will undergo judicial review or be pre-emptively struck down by policies submitted to Congress.
Who Does Not Have to Comply With the Work Stipulation Set?
Ordinarily, the following categories are exempt:
- People with disabilities
- Women who are expectant mothers
- Seniors (65+)
- Primary caregivers of minors or persons with physical or mental health impairment
- Medically fragile persons
- Students
Exemptions, however, may differ from region to region, while those meeting the criteria might need to present some form of proof in order to not drowning in more red tape.
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What Does the Data Indicate?
According to the Kaiser Family Foundation (KFF), approximately 80 percent of non-disabled working-age adults who are on Medicaid do currently have a job or are enrolled in schooling. The other 20 percent face other dire challenges like taking care of illness, being a caregiver, or lack of adequate means for getting to places, transport.
KFF observations indicate the existence of a support structure for employment or education programs, such as in Arkansas, where activities were conducted, where employment prerequisites were set to be flexible.
Other Available Options
Instead of imposing punitive work requirements, some constituents have suggested:
- Provide comprehensive child and transport accessibility
- Fund job readiness and employment aid programs
- Integrate healthcare with employment services
- Offer multiple participation options such as reporting via phone, in-person meetings, or mobile applications
Health coverage is unlikely to be restricted with the implementation of these strategies, but better employment results may be achieved instead.
A Policy That Could Have Significant Consequences
Making changes to work requirements for Medicaid is not a policy change; they are a profound change regarding public assistance. Thinking of linking health care to an individual’s employment triggers far-reaching consequences for those living at the poverty level, sans access to stable employment, health conditions, or caregiving duties.
What Supporters Believe
Supporters of the change believe it promotes personal responsibility and less dependency on government aid, but the reality is that it tends to cause adverse impacts such as overspending, lost coverage, red tape, and wasted funding.
While the legal and political disputes rage on, one thing is evident: there is an utmost need to change the approach used to set health policy from overspending needlessly, and focus on providing care by using the lived experiences of affected individuals.
Know About Medicaid Work Requirement With Benefits By State
Find out how Medicaid work prerequisites apply to you at benefitsbystate.com. We provide current information at the state level so you can comprehend eligibility, understand changes, and receive the benefits you are eligible for. If you still need more assistance, contact our experts.
FAQs
What states have work requirements implemented for Medicaid?
At the moment, no state has active work requirements for Medicaid. Some states are trying to do it, Arkansas, Indiana, and even Michigan. But most were blocked by courts or rolled back by the Biden administration.
Why don’t Medicaid work requirements work?
Work requirements in Medicaid do not often work because they do not raise employment levels and instead increase the loss of coverage. A lot of individuals lose coverage due to confusion, paperwork, or even an unstable job situation, regardless of whether they’re working.
Why would someone be denied for Medicaid?
Someone can be denied Medicaid because their income is higher than the qualifying threshold, a parole missing documents, not satisfying residency or citizenship criteria, or failure to renew coverage promptly.
