The Trump
Change seen as burden by critics, likely to shrink rolls
administration clears the way for states to impose work requirements on many Americans who depend on Medicaid, the government health insurance program for the poor.
WASHINGTON — The Trump administration cleared the way Thursday for states to impose work requirements on many Americans who depend on Medicaid, the mammoth government health insurance program for the poor.
The long-expected move — which was strongly condemned by patient advocates, physicians and consumer groups — would mark the first time in the program’s half-century history that the government will require people to work in exchange for health coverage. In states that decide to impose the new requirement, it is widely expected to shrink Medicaid rolls.
The new plan sets the stage for a potentially long and contentious legal battle over the shape and purpose of a health program that more than 70 million Americans now depend on.
The administration outlined the work-requirement plan in a letter to state Medicaid officials that indicates the administration’s willingness to grant state requests to impose requirements on working-age, nondisabled Medicaid beneficiaries.
“Medicaid needs to be more flexible so that states can best address the needs of this population,” said Seema Verma, who oversees the Medicare and Medicaid programs at the Department of Health and Human Services and has long called for putting new requirements on Medicaid patients, including charging them more for their care.
Many patient advocates note that a small fraction of the people covered by Medicaid are of working age, non-disabled and currently unemployed. The main impact of the rules will be to subject poor people to stacks of paperwork that will drive some to drop coverage, the critics say.
“Medicaid was designed as a health care program, to provide vulnerable members of our society with access to care they badly need,” said Dr. Jack Ende, president of the American College of Physicians.
“Work requirements impose an additional, unnecessary barrier to allowing patients access to vital health care services for people who need access and coverage the most. … We need to work together to find ways to improve the program, instead of restrict it.”
Other groups criticizing the Trump administration’s plans included Public Citizen, Families USA and the advocacy arm of the American Cancer Society.
Several experts noted that threatening to strip coverage from poor people who are not working is inconsistent with the program’s legal mission to improve health and therefore could be subject to challenge in court.
The administration is nonetheless expected to quickly approve requests from as many as 10 states, all but one of which has a Republican governor.
The states are: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.
Many other states are not expected to impose work requirements.
Verma and other conservatives argue that forcing working-age Medicaid beneficiaries to work or seek work — a strategy used for years in other federally funded aid programs for the poor — will improve their health.
“States … want more flexibility to engage their working-age, able-bodied citizens on Medicaid,” Verma told a gathering of state Medicaid directors in November. “They want to develop programs that will help them break the chains of poverty and live up to their fullest potential. We support this.”
Critics of the Trump administration’s approach note that a growing body of evidence shows that Medicaid health coverage is helping many Americans improve their health and their finances, not holding them back, as Verma and other have suggested.
A large majority of Medicaid recipients — almost two-thirds — are children, elderly or disabled. They will be exempt from the new requirements.
According to a recent analysis by the nonprofit Kaiser Family Foundation, 6 in 10 of the nearly 25 million working-age, non-disabled adults on Medicaid are already working full-time or part-time.
Of the remaining 10 million unemployed Medicaid enrollees, more than a third had an illness that prevented them from working, about another third were taking care of a family member, 15 percent were in school, 9 percent were retired, and 6 percent said they couldn’t find work.
Trump administration officials said Wednesday they would ensure that Medicaid enrollees in states with a work requirement would still get covered if they are involved in a “community engagement” activity, such as taking care of a family member, seeking work or job training.