31 Jul ARE MEDICAID WORK REQUIREMENTS COMING BACK?
In 2018, the Trump Administration and GOP made multiple attempts to reverse the ACA and establish federal spending caps on the Medicaid program to lower costs. These efforts were unsuccessful; nevertheless, several states expanded their Medicaid programs and introduced work requirements during this time.
According to KFF, one out of five Americans receive health care through Medicaid. The program has become the country’s largest source of health care coverage and accounts for 27% of total state expenditures. Due to program expansion and expenses, House Republicans revived their push for work requirements over the spring during debt ceiling negotiations with Democrats. They also suggested reforming the work requirements for people receiving food and cash assistance through SNAP and TANF.
The Medicaid work requirement provision did not make it through negotiations; however, President Biden agreed to the expanded work requirements for food and cash support in exchange for a two-year suspension of the debt ceiling. Despite the outcome in Washington, some states still pursue work requirements for their Medicaid programs through section 1115 waivers.
Even though Medicaid is a jointly funded program between the federal government and states, the states are responsible for administering it, and the Social Security Act allows them the flexibility to modify their programs through Section 1115 waivers. These waivers require approval from the Secretary of Health and Human Services. They can modify eligibility requirements or suspend provisions of federal law under the condition that the projects support the goals of the Medicaid program.
States first employed Section 1115 waivers to implement work requirements in 2017 under the Trump Administration. During that time, twelve states received approval from HHS. Soon after, the Trump Administration was sued by health care advocates and civil rights groups, overturning the work requirement regulations in Arkansas and Kansas. Consequently, other states were also disallowed from implementing their provisions.
Pathways to Coverage – GA’s Work Requirements
Shortly after President Biden transitioned into office, he reversed several other waivers that provided states approval to implement Medicaid work requirements. Georgia was one of the states affected by the decision and sued the administration. The District Court for the Southern District of Georgia ruled in support of the state, citing that the administration did not consider whether reversing the GA’s waiver would cause less Medicaid coverage. Georgia has become the only state with a work requirement for Medicaid eligibility, and the state’s program, Pathways to Coverage, launched at the beginning of this month.
Work requirements have become a topic of debate among health care professionals and government officials. Some view the conditions as barriers to health coverage that go directly against the objectives of the Medicaid program. They assert that Medicaid is designed to provide insurance, not encourage employment. However, work requirement proponents say that the program has broadened far beyond its original objective, and states must rein in costs. At the moment, states are navigating eligibility determinations, and vulnerable populations need their health care coverage. Setting the work requirement debate aside, all states should be looking for ways to improve efficiency and cost avoid in their Medicaid plans.