Why the Current Workforce System is Not Suited to Help Medicaid Beneficiaries Meet Work Requirements

By Renato Rocha & Anna Cielinski 


For the first-time in the 53-year history of Medicaid, the federal Centers for Medicare and Medicaid Services (CMS) issued guidance in January saying it would consider state proposals to take health coverage away from people who don’t meet work requirements. Since then, over a dozen states have requested such waivers from CMS, with Arkansas the first to implement.


However, the January guidance made clear that CMS would not allow states to use Medicaid funds for the costs of providing job training or related services to Medicaid recipients. Many states have therefore suggested that “workforce development” programs will help Medicaid participants meet these requirements and keep their health coverage.

Many human services professionals have questions about the structure, funding, and services of our nation’s workforce development programs—and whether these programs have the capacity needed to prevent Medicaid recipients from losing coverage. That’s why the Center for Law and Social Policy (CLASP)  has recently published two companion resources: “A Primer on Federal Employment and Training Programs For Human Services Advocates” and “Workforce System not Funded or Structured to Help Medicaid Recipients Keep Health Care.” These pieces, which are intended to provide advocates with a basic understanding of the programs available, underscore the following:

  • The Workforce Innovation and Opportunity Act (WIOA) is the flagship federal investment in employment and training programs. It provides federal funding for employment services, some occupational training, and education to help unemployed and underemployed workers pursue better jobs. It also supports a network of American Job Centers, known as “one-stop centers,” where job seekers can find information on job openings, training, and career opportunities. However, the structures and functions of the programs are often not set up well for public benefit recipients.
  • WIOA and other workforce programs are already significantly underfunded. Federal investment in employment and training services has been decreasing over the last 40 years, with a sharp drop beginning in 2003, making services less frequent and intensive for those who need them most. Given existing funding constraints on the system, WIOA could not absorb the added people who would be subject to Medicaid work requirements and are not working or eligible for an exemption.
  • WIOA programs would face challenges adequately serving an influx of participants who have significant employment barriers. WIOA programs typically start with very low-touch “job search” in which individuals use job center computers to search and apply for jobs or work on resumes and cover letters. The great majority of these participants will never get beyond job search to more intensive services such as occupational training. In particular, this light-touch service will be inadequate for Medicaid beneficiaries who face significant barriers to employment, including the more than one in three unemployed adults receiving Medicaid—but not receiving Disability/Supplemental Security Income—and report an illness or disability as their primary reason for not working.

These two new publications make clear that our nation’s workforce system is not funded or structured to help Medicaid beneficiaries meet work requirements. We know what people need to become economically secure: increased funding for high-touch, high-quality education and training through WIOA, along with affordable child care and transportation services. CLASP will continue to work with advocates to help public benefit recipients navigate these new barriers in Medicaid and oppose proposals that take away health care from people who don’t meet arbitrary onerous work requirements.