Medicaid Work Requirements Revoked. The CTC Shouldn’t Go Down this Path.


By Suzanne Wikle

The Biden Administration has significantly improved access to affordable health care during the past year, including by breaking down barriers for enrolling in Medicaid. For example, the Centers for Medicare and Medicaid Services (CMS) has rescinded approval of the Trump Administration’s illegal waivers for states to implement work requirements in Medicaid. Although the waivers didn’t survive court challenges, the state waivers that took effect before being shut down caused significant loss of health insurance, including for those who should have been exempt from the work requirements.

With the dismissal of Georgia’s request in recent weeks, the Biden Administration has officially ended these policies for Medicaid. Unfortunately, other benefit programs still use so-called work requirements. Policymakers must also end these, and they should dismiss any consideration of work requirements for the child tax credit (CTC) and other programs.

Work requirements are racist, and there is ample evidence they prevent eligible people from accessing benefits such as cash and food assistance. The Temporary Assistance for Needy Families (TANF) program and the Supplemental Nutrition Assistance Programs (SNAP) both have work requirements that are deeply rooted in racism and draw on a shameful history of categorizing people as “worthy” or “unworthy” for basic life needs. Again and again, work requirements have failed to do anything other than create barriers to benefit programs.

Unfortunately, some members of Congress have suggested adding a work requirement for the CTC in the Build Back Better package. Under last year’s American Rescue Plan, the CTC was temporarily made available to families with little to no earnings. This increased access to the CTC, especially for Black and Hispanic families who were more likely to be denied the full CTC under prior law because they earn too little.

The problems with work requirements are numerous and include:

Harming communities of color. Systemic racism across people’s lives—ranging from employment discrimination to fewer jobs available in communities of color—all affect their ability to work. Furthermore, Black and Hispanic people, especially women, report higher levels of involuntary part-time work when they would prefer full-time work.

Adding confusion to eligibility requirements. Regardless of how a work requirement would be structured in the CTC, it will add administrative complexity and confusion. Some children in families with the lowest incomes would lose eligibility for the credit, while other families would be deterred by the fear of possibly owing money back to the IRS.

Increasing stress during job loss. Losing a job is a stressful experience, especially for families who live paycheck to paycheck. The CTC helps families weather unexpected income loss. Tying the CTC to employment would create additional stress and reduce families’ incomes further.

Failing to reflect the realities of our economy. Work comes in many forms, including part time, seasonal, full time, and unpaid caregiving for family members and others. Policies judging what constitutes work simply do not reflect the reality of our economy and people’s lives.

Harming persons with disabilities and illness and their families. Many people who are unable to work due to disability or illness may not have official documentation of their disability or illness, which is often difficult, time-consuming, and costly to obtain. Even when policymakers have tried to design carve-out exceptions for people with disabilities or illness, the complexity of proving disabilities and the ability to understand the policy nuances leads many people with disabilities and illnesses to being excluded from a benefit that has a work requirement. Including such a requirement in the CTC would also cause burden for caregivers of children with disabilities, who are likelier to need to take leaves of absence from their jobs to care for their children’s medical needs.

The CTC has proven to be an overwhelmingly powerful policy to reduce child poverty. Let’s keep what works and avoid pitfalls that have proven to put up paperwork barriers and keep eligible people from accessing a program. Congress needs to extend the revamped CTC with monthly payments to families, and in a way that will continue to ensure the policy meets its goal of reducing child poverty and alleviating families’ financial stress.

Adding a work requirement to the CTC would be a big policy misstep, causing the most harm to families with the lowest incomes, families of color, and families who don’t have the time to navigate more bureaucracy. Instead, let’s look at the facts and trust families – CTC payments are helping them pay for food, bills, school supplies, and other necessities. Let’s learn from the past and do better as we build back better.