Medicaid Work Requirements

Update: July 14, 2020

Today, the Trump Administration filed a petition asking the U.S. Supreme Court to reverse rulings that struck down work requirements for Medicaid recipients sought by Arkansas and New Hampshire. This action follows the February 2020 decision by the U.S. Court of Appeals for the D.C. Circuit to unanimously uphold the decision reached by a federal district court in 2019 overturning HHS’ approval of Arkansas’ Medicaid waiver.

The Court of Appeals found that approval of the waiver violated the Administrative Procedure Act because HHS did not consider how the waiver would further “the principal objective of Medicaid,” providing access to healthcare. The court also importantly noted that while the objectives of Medicaid do include promoting independence, that refers to the provision of “rehabilitative and other services, not financial independence from government welfare programs,” which is the primary objective of work requirements.

In the petition to the Supreme Court, the Trump Administration argues that the court of appeals wrongly decided the case and that the ruling “casts a shadow” on multiple other states’ approved or pending work requirement waivers and “threatens to impede innovations” that may make state Medicaid programs more “sustainable.” The Arkansas Attorney General also filed a request for the Supreme Court to review the case.

Responses by the attorneys for the plaintiffs are due in mid-August. We will continue to monitor this litigation and other efforts to implement work requirements around the country.

For the first time, the federal government is allowing states to require people to work to access healthcare through Medicaid. Federal courts have struck down the government’s approvals of work requirements in several states for conflicting with Medicaid’s purpose – to provide health coverage to people who cannot otherwise afford it. However, litigation on Medicaid work requirements is ongoing, as the Trump Administration recently filed a petition asking the U.S. Supreme Court to reverse lower court rulings striking down work requirements in Arkansas and New Hampshire. Work requirements could have devastating consequences for people with disabilities, causing many people to lose their Medicaid.

The federal government has said work requirements only apply to people who are “able-bodied.”   Even though some people with disabilities (like people who meet the strict criteria for “disabled” for purposes of Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)) may be exempted, many other people with disabilities or chronic conditions who do not meet these strict standards will be subject to these policies. Therefore, millions of people on Medicaid who have disabilities or “pre-existing conditions” could still be subject to work requirements.  In addition, caregivers of people with disabilities could also be forced to choose between providing care to their family member or lose their own access to Medicaid.

Our biggest concerns:

Losing Medicaid Coverage

• Thousands of people will lose Medicaid coverage in each state that implements work requirements.
  • In Arkansas, the first state to implement a work requirement (before a court struck it down), over 18,000 people lost Medicaid coverage between August and December 2018. 
• Many people with disabilities do not have the medical documentation they need to show that the meet the exemption from a work requirement.
  • The standards for these documents are very high, often requiring assessments and special services that most people cannot afford, even with their insurance.
  • People will have to resubmit these documents often, so the process itself will be a burden for many people with disabilities
• States punish people who cannot find work by taking away their health insurance, making it harder for them to stay healthy and less able to find and maintain work.

Barriers to Accessing Medicaid

• Many people who have relied on Medicaid for years will not know they have to submit this paperwork and could face losing their insurance or gaps and delays in their coverage.
• Other barriers to accessing health care and employment prevent people with or without disabilities from getting these documents (like discrimination, access to transportation, or access to a doctor), so they will lose insurance for factors beyond their control.
• These policies also hurt family caregivers, who are “exempt” from the work requirements, but have to meet strict criteria and go through a long process to prove it.

Administrative Burden Makes it Even Worse

• States that implement work requirements will have to create a new process to screen applicants for Medicaid which will take funding away from health care services for those receiving Medicaid.
• People who are injured or disabled may need to wait months without health insurance before their documents are processed.
• State errors in work requirement programs are incredibly common, and people with disabilities and caretakers are more likely to lose coverage during periods of leave or unemployment when they should be exempt.

What does this mean for your state?

CMS has already approved Medicaid waivers with work requirements in a number of states, and additional states have requests pending to add work requirements to their Medicaid programs. However, federal courts have struck down CMS’ approvals of Medicaid work requirements in several states (Arkansas, Kentucky, Michigan, and New Hampshire).

For information about your state see: 

•  Medicaid Waiver Tracker, Kaiser Family Foundation

What Can You Do?

• Call your Governor’s office and let them know that you oppose Medicaid work requirements.
  • Governors decide to submit the work requirement waivers. If you live in one of the states where these waivers have been submitted or approved, call your Governor to tell them how disappointed you are.
  • If you live in a state that has not yet requested this waiver, urge your Governor to issue a statement explicitly saying that they will not pursue Medicaid work requirements.

• Call your Members of Congress and urge them to oppose Medicaid work requirements.
  • If your member of Congress already has opposed them, thank them for their support and ask them to remain vocal in their opposition.
• CMS is required to hold a public comment period for each waiver that is requested. Make your voice heard and submit your comment today!

Work requirements are being imposed on other programs that are important to people with disabilities and their families.  To learn more, visit Work Requirements Beyond Medicaid.