By Ariel Cohen

Experts believe that HHS’ recent (Aug. 30) move to roll back an Obama-era rule that allowed states to adjust Temporary Assistance for Needy Families (TANF) work requirements could indicate the agency will soon begin approving and implementing Medicaid work requirements.

The recent HHS ruling rescinds guidance from 2012 that allowed and encouraged states to apply for waivers proposing alternative ways to measure work and what counts as such under TANF work requirements — though it did not fully eliminate work requirements for the program. Experts say eliminating these waivers will not impact the program, as the policy never really took hold and no states ever received waiver approval.

The announcement that states could propose alternative ways of getting people to work came out in the summer of 2012 right before the election. It was immediately picked up by the Romney campaign as gutting work requirements in TANF. It was completely political spin, it wasn’t reality, explained a longtime TANF policy expert.

As a result of the political nature of the Obama-era TANF waivers, only one state, Ohio, submitted a formal request to reformat the way work was accounted for in its TANF program. But the Obama administration never responded to the request. Then the Trump administration sent a letter to Ohio Gov. John Kasich (R) denying the state’s waiver request at the same time that it rolled back the Obama-era rule regarding TANF waivers. One health policy expert said Ohio was very disappointed the request was turned down.

“The content of these TANF waivers have no effect on Medicaid, but I think what matters is the signaling, since Price is doubling down on work requirements as being a good thing,” said Senior Policy Analyst at the Center for Law and Social Policy Elizabeth Lower-Basch “Given that we are all waiting on CMS’s response to some of the Medicaid waiver requirements, this is certainly another sign on top of the letter Seema Verma submitted saying CMS was likely to approve some of or all of these waivers [that had been previously rejected by the Obama administration].”

Six states–Indiana, Arizona, Arkansas, Kentucky, Maine, and Wisconsin — have all recently proposed waivers that include work requirements for Medicaid beneficiaries. If CMS were to agree to any of these waiver proposals, it would mark the first time the agency has approved a work requirement for Medicaid. But work requirements have generally not been popular — Kentucky received more than 1,800 comments on its waiver request, with about 90 percent of commenters against it, according to an analysis from the Kentucky Center for Economic Policy. Some experts also say Kentucky’s waiver may be ready for approval, but concerns about the public’s reaction could be holding that up.

Since Trump came into office, the new administration has pushed to give states more flexibility in the Medicaid waiver process and has discussed the possibility of work requirements. Experts think the TANF announcement is just the first shoe to drop.

“It’s political. It fits in their rhetoric of work requirements and wanting to extend work requirements to other programs,’ another health care policy expert said.

In an op-ed published the day after HHS made the TANF announcement, HHS Secretary Tom Price hinted that this was just the first step toward work requirements.

“Everyone intuitively understands that people need good health in order to work, but fewer people think about how beneficial work can be to maintaining good health. Encouraging work is a fundamental part of our mission at HHS to improve the health and well-being of the American people,” Price wrote.

Senate Finance Committee Chairman Orrin Hatch (R-UT) praised the agency’s decision on Friday (Sept. 8), saying that requiring TANF recipients to work will make them more likely to get off welfare.

“Strong work requirements encourage self-sufficiency and help beneficiaries reenter the workforce,” Hatch said. “The move by HHS to rescind the Obama-era rule and allow states to skirt this important element will better encourage and support vulnerable families.”