Mandating employment for Medicaid eligibility

Understanding the Intersection of Medicaid and Work

By Rachel Garfield, Robin Rudowitz, and Anthony Damico   
Kaiser Family Foundation, January 5, 2018

As of December 2017, 32 states have implemented the ACA Medicaid expansion.1 By design, the expansion extended coverage to the working poor (both parents and childless adults), most of whom do not otherwise have access to affordable coverage. While many have gained coverage under the expansion, the majority of Medicaid enrollees are still the “traditional” populations of children, people with disabilities, and the elderly.

Some states and the Trump administration have stated that the ACA Medicaid expansion targets “able-bodied” adults and seek to make Medicaid eligibility contingent on work. Under current law, states cannot impose a work requirement as a condition of Medicaid eligibility, but some states are seeking waiver authority to do so.

This issue brief provides data on the work status of the nearly 25 million non-elderly adults without SSI enrolled in Medicaid (referred to as “Medicaid adults” throughout this brief) to understand the potential implications of work requirement proposals in Medicaid. 

Data Findings

* Among nonelderly adults with Medicaid coverage—the group of enrollees most likely to be in the workforce—nearly 8 in 10 live in working families, and a majority are working themselves.

* Most Medicaid enrollees who work are working full-time for the full year, but their annual incomes are still low enough to qualify for Medicaid.

* Many Medicaid enrollees working part-time face impediments to finding full-time work.

* Nearly half of working adult Medicaid enrollees are employed by small firms, and many work in industries with low employer-sponsored coverage offer rates.

* Among the adult Medicaid enrollees who were not working, most report major impediments to their ability to work.

Policy Implications

* Under current law, states cannot impose a work requirement as a condition of Medicaid eligibility.

* Some states have proposed tying Medicaid eligibility to work requirements using waiver authority that may be approved by the Trump Administration.

* Research shows that Medicaid expansion has not negatively affected labor market participation, and some research indicates that Medicaid coverage supports work.

* Implementing work requirements can create administrative complexity and put coverage at risk for eligible enrollees who are working or who may be exempt.


Verma Outlines Vision for Medicaid, Announces Historic Steps Taken to Improve the Program, November 7, 2017

In a significant shift from prior policies, in speaking about the new approach to Section 1115 demonstrations, Seema Verma emphasized the agency’s commitment to considering proposals that would give states more flexibility to engage with their working-age, able-bodied citizens on Medicaid through demonstrations that will help them rise out of poverty. engagement and work activities.

“We will not just accept the hollow victory of numbers covered [in the program], but will dig deeper and demand more of ourselves and of you,” said Verma. “For those unable to care for themselves, we will create sustainable programs that will always be there to provide the care you need, to provide choices and allow you to live as independently as possible. For those that just need a hand up, we will provide you the opportunity to take charge of your health care and assist and empower you to rise out of poverty and government dependence to create a better life for yourselves and your family.”


Daugaard: S.D. seeking to impose Medicaid work requirement

By James Nord
Sioux City Journal, January 9, 2018

South Dakota is asking the Trump administration to allow the state to require some Medicaid recipients to work to qualify for the government-funded health coverage for the poor, Gov. Dennis Daugaard said Tuesday in his State of the State address.

"Work is an important part of personal fulfillment," Daugaard said. "By making this adjustment to our Medicaid program, we can continue to help those who need it the most and start to connect those who can work with jobs that give them that sense of self-worth and accomplishment."

The governor has made workforce development a key policy focus. He said South Dakota doesn't have enough workers in many skilled fields, which is a barrier to economic growth. In metro Sioux City, which includes Union County, unemployment below 3 percent has made it more difficult for new and expanding workers to find qualified applicants.



By Don McCanne, M.D.

With encouragement oƒ CMS Administrator Seema Verma, many states are now applying for Medicaid Section 1115 waivers that would allow them to establish work requirements as a condition for enrollment in the Medicaid program. There are two policy issues here - health care and jobs.

Public policies should be established to ensure that everyone has access to affordable health care and that jobs are available for those who need employment. Since Medicaid was designed to help low-income individuals and families, then  everyone who is qualified on an income basis should automatically be covered. Also the government should support jobs programs to minimize the scourge of unemployment.

Instead, our current government administration is driven by ideology that would achieve the opposite results. They would place the burden of obtaining employment on the individuals, even when there are essentially no jobs available. Then to penalize them for their failure, they would deprive them of their Medicaid coverage. Seema Verma refers to this as empowering them "to rise out of poverty and government dependence to create a better life for yourselves and your family." No job, no health insurance does not make for a better life. South Dakota Gov. Dennis Daugaard is about to show us the perversities of these policies. Besides, the Kaiser Foundation paper shows us that they are attempting to address a problem that hardly even exists.

What policies do we have that would deprive Medicare beneficiaries of their coverage? Of course, we do not have any such policies. Medicare is a social insurance program that is a right for those qualified. We don't use the threat of cancellation as a stick to shape people up. We simply give them medical care when they need it.

Medicare does need some major revisions to make it a better program. Then it can be used to provide automatic health care coverage for absolutely everyone. Then we can go to work to be sure that every individual has a right to employment within the limits of their capabilities. When the private sector doesn't come through, there are plenty of potential public projects that can make this a better nation for all of us.

But first we have to select government stewards who have their policy priorities aligned with the people. Democracy anyone?

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