31 Jul MEDICAID’S PROPOSED WORK REQUIREMENTS
In 2018, the Trump Administration and GOP made numerous efforts to overturn the ACA and establish federal spending caps on the Medicaid program to decrease costs. These initiatives were ultimately unsuccessful; however, 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 safety net 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 costs, House Republicans revived their push for work requirements over the spring during debt ceiling negotiations with Democrats. They also suggested expanding the work requirements for individuals receiving food and cash assistance through SNAP and TANF.
The Medicaid work requirement did not make it through negotiations; however, President Biden agreed to expand 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 are still pursuing work requirements for their Medicaid programs through Section 1115 waivers.
Even though Medicaid is a jointly funded government program between the federal government and states, the states are responsible for administering it, and the Social Security Act permits them the flexibility to modify their programs through Section 1115 waivers. These waivers require approval from the Secretary of Health and Human Services and can amend eligibility requirements or forgo provisions of federal law under the condition that the projects promote the objectives 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. Shortly after, the Trump Administration was sued by health care advocates and civil rights groups, reversing the work requirement regulations in Arkansas and Kansas. Consequently, several other states were also prohibited from implementing their provisions.
GA’s Work Requirements
Not Long after President Biden transitioned into office, he reversed several other waivers that gave states approval to implement Medicaid work requirements. Georgia was one of the states impacted by the decision and sued the administration. The District Court for the Southern District of Georgia ruled in favor of Georgia, citing that the administration did not consider whether reversing the state’s waiver would cause less Medicaid coverage. Georgia has become the only state with a work requirement for Medicaid eligibility, and the state’s plan, Pathways to Coverage, launched at the beginning of this month.
Work requirements have once again 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 argue that Medicaid is designed to provide insurance, not encourage employment. Meanwhile, work requirement supporters say that the program has grown far beyond its original objective, and states must control costs. Presently, vulnerable populations are at risk of losing coverage as states are navigating eligibility determinations. Setting the work requirement debate aside, all states should be looking for ways to improve efficiency and avoid cost in their Medicaid plans.