Medicaid shouldn’t have a work requirement

Since Medicaid was created more than 50 years ago under President Lyndon B. Johnson, millions of low-income adults, children, pregnant women, people with disabilities and seniors in nursing homes have had the peace of mind knowing their health and well-being are protected because they can access Medicaid coverage. Now the Trump administration is rewriting the rules to create barriers to this coverage by allowing states to mandate a work requirement as a condition of coverage. Linking coverage to work will undermine access to health care for many, and is cruel, counterproductive and unnecessary.

On Jan. 11, the administration released guidance allowing states to implement work requirements on Medicaid beneficiaries, a major change in federal policy. The objective of Medicaid has been to serve the health and wellness needs of our nation’s vulnerable and low-income individuals and families. Imposing work requirements flies in the face of this objective.

Simply put, work requirements would do a disservice to our nation’s most vulnerable. You have to be healthy to be able to obtain and keep a job. How can you do that if you are sick and can’t get care?

Furthermore, the problem this policy sets out to solve doesn’t even exist.

We have all heard the false characterization that poor, able-bodied people are taking advantage of Medicaid, but the truth is most adults on Medicaid actually are working. According to the Kaiser Family Foundation, a non-partisan policy analysis and research center, nearly 8 in 10 nonelderly, non-disabled adults with Medicaid live in working families, and most are working themselves. Among those who did not work in 2016, 36 percent were ill or disabled, 30 percent were caregivers, and 15 percent attended school. The other 18 percent were either retired, could not find work or had another reason. Among Medicaid recipients in Texas, 67 percent are children, though 60 percent of the costs are spent on the elderly and disabled individuals.

Does grandma need to get a job? Do kids?

Imposing such policies on Medicaid families that are generally living on a budget of roughly less than $15,000 per year is a punitive action that will hurt American families living paycheck to paycheck.

At their core, work requirements policies assume that individuals should work in order to have health care, when the opposite is plainly true: Health is essential for successful employment.

Before the Trump administration announced its decision, 10 states asked the Centers for Medicaid and Medicare Services (CMS) for permission to add work or work-related requirement to their program. The day after CMS’s Jan.11 announcement, Kentucky became the first state to have its Medicaid waiver with a work requirement approved. People in Kentucky have more access to care and are healthier than they have ever been, thanks to the Affordable Care Act’s Medicaid expansion. Now, Kentucky’s governor would rather reverse this progress by instituting premiums, increasing cost-sharing and dis-enrolling beneficiaries for not renewing eligibility or reporting changes in income, as the waiver will do.

If the main purpose of the work requirement is to emphasize work to promote health and well-being, then instead of creating barriers to health care, states should be looking to provide better tools to secure employment, such as housing stability services and supported employment services. Washington State implemented these sorts of ideas through something called a “Section 1115 waiver” in 2017. Section 1115 waivers grant states flexibility with the goal of promoting the objectives of Medicaid. A work requirement would do the opposite.

As former vice president Hubert H. Humphrey said, “It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.”

If a society is indeed judged by the manner in which it treats its most vulnerable, what does the recent CMS decision say about the nation’s commitment to achieve health and well-being for this population?