Work Requirements in Medicaid Would Add More Red-Tape and Barriers to Health Coverage

This was originally published on the Georgetown Center for Children and Families' Say Ahhh! blog. 

By Suzanne Wikle

Having failed to cut Medicaid through legislation, the Trump Administration is moving forward with administrative actions that would permit states to impose roadblocks to enrollment. We anticipate that the administration may soon grant waivers that would for the first time allow work requirements in Medicaid, modeled off of similar federal provisions in Temporary Assistance for Needy Families (TANF) and the Supplemental Nutrition Assistance Program (SNAP). Adding work requirements to Medicaid is a terrible idea for several reasons, including:

  • People would lose their health insurance. In fact, the nonpartisan Congressional Budget Office said that states would use work requirements to reduce enrollment in Medicaid. This holds true when you look at the waivers submitted to CMS. For example, Kentucky estimates that its waiver, which includes a work requirement, would cause 95,000 fewer people to be insured by Medicaid if the waiver is approved.
  • Employment outcomes won’t improve. Lessons learned from other programs demonstrate that work requirement policies do little to help people find and keep work and, in fact, are ineffective at connecting people to living-wage jobs that provide affordable health insurance. A better policy focus would be to invest in programs designed to help people develop skills and training for in-demand jobs, help people get the education they need to climb the career ladder, and foster an economy that creates more jobs.
  • People may find it harder to work or stay employed. Medicaid expansion enrollees from two states reported that having Medicaid made it easier to look for employment and stay employed. Making access to Medicaid more difficult may have the exact opposite effect on employment.
  • The reality of today’s economy and jobs is very different than what these policies envision. Many Medicaid enrollees already work—often in industries like retail and food service—yet because their jobs do not provide health insurance benefits, they continue to rely on Medicaid for affordable health insurance.
  • Additional red tape and bureaucracy will be a barrier to enrollment for everyone. New paperwork requirements will cause many people, including those who are eligible, from completing the application and enrollment process.

The bottom line is that policies purporting to be “well-intentioned,” such as work requirements, play out very differently in reality and often cause unnecessary burden on families that are already experiencing high levels of stress just to get by on a day-to-day basis.

Some of the states that have proposed work requirements would only target childless adults. However, at least five states include parents, which would have negative effects on their children. First, disruptions in parents’ coverage make it more likely that parents won’t be healthy enough (either physically or mentally) to be at their best for their children. Second, when parents are uninsured, children are less likely to have health insurance and a regular source of care.

These are just a few of the reasons why a work requirement in Medicaid is short-sighted. Read our recent FAQ to learn more about lessons from TANF and SNAP and why work requirements are the wrong path forward for Medicaid. Legislative cuts to Medicaid were defeated by a broad coalition of health advocates, consumers, providers, and children’s organizations. Fighting back on these waiver proposals will require a similar effort.