Work Requirements: A Harmful Shift for Medicaid

Kaitlin Brown
January 18, 2018

You may have heard a lot about work requirements in the news lately. Last week, the Centers for Medicare and Medicaid (CMS) announced that they would begin approving states’ requests for Medicaid work requirements, allowing states to make access to healthcare conditional based upon workforce participation. What’s worse, this new process could potentially open the door to other expensive and ineffective requirements for recipients of healthcare. Last Friday, Kentucky’s Medicaid work requirement was the first approved in over fifty years of the Medicaid program, and it is likely that other states will quickly be approved (nine other states have already submitted proposals). We believe that access to healthcare is a human right, and receiving coverage should not be conditional on employment status.

The vast majority of adults receiving Medicaid are either working, in school, or caregivers. Many other adults receiving Medicaid have serious health issues that preclude them from working. With work requirements in place, cancer patients for instance who are no longer on traditional employer insurance, would now need to go through a waiver process to prove that they are not able to work, adding an undue burden for people who are medically vulnerable.

Before the Affordable Care Act’s Medicaid expansion (when many states increased eligibility for people earning up to 138% of the federal poverty line, about $33,948 for a family of four), there were fewer working adults on Medicaid. Now, more than half of Medicaid recipients are working, many in jobs that neither provide employee health coverage nor pay enough for employees to buy their own insurance on the marketplace. This might be a family where both parents are working in low-wage jobs in a company that isn’t large enough to provide insurance, or an individual working multiple part-time jobs.

Medicaid recipients who are not working report that they cannot because of their own medical issues, lack of employment options in their area, and/or caring for children or elderly family.1 Moreover, Medicaid is not structured like other social safety net programs, such as the Supplemental Nutrition Assistance Program (SNAP), to provide job training. Imposing work requirements therefore would leave many recipients stuck in low wage jobs with little chance of advancement.

Work requirements will also disproportionately hurt women. Women are more likely to be caregivers for children or other family members, or to be employed in non-traditional settings that do not provide high wages or employer-sponsored insurance. These women would then be forced to choose between high-cost childcare and losing their access to healthcare.

The administration’s decision to institute work requirements for the most vulnerable goes against what we stand for. It puts an additional burden on people who are sick or experiencing poverty, and puts the burden on a system that is not set up to provide adequate training for those joining the workforce.


Read more:

“Understanding the Intersection of Medicaid and Work.” Rachel Garfield, Robin Rudowitz. The Henry J. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work/

“Medicaid and Work Requirements: New Guidance, State Waiver Details and Key Issues.” MaryBeth Musumeci, Rachel Garfield, and Robin Rudowitz. The Henry J. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/medicaid-and-work-requirements-new-guidance-state-waiver-details-and-key-issues/

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