Commentary

Trump administration pushes for wasteful, ineffective work requirements in Medicaid

Yesterday, health care advocates in North Carolina and across the U.S. were officially alerted to yet another fight to ensure that people retain health coverage and access to care. While officials in the Trump administration’s Centers for Medicare and Medicaid services (CMS) are framing their new “Dear State Medicaid Director letter” as “new policy guidance for states to test community engagement for able-bodied adults,” the real purpose is to create work requirements and other barriers for people seeking to enroll in and keep their Medicaid coverage.

As North Carolina has not expanded Medicaid, the only adults who are eligible for coverage are pregnant women with incomes of up to 196 percent of the federal poverty level, parents and/or caretakers with incomes up to 44 percent of the federal poverty level, and the aged, blind and disabled.

However, North Carolina currently has a pending Section 1115 Waiver proposal before federal officials that would transform Medicaid. The amended waiver application has language referencing Carolina Cares or HB 662, which would increase access to Medicaid to adults up to 138 percent federal poverty. While Carolina Cares is awaiting legislative action from the General Assembly, it should be noted that Carolina Cares has language to impose work requirements if it should be enacted.

The idea of formal, bureaucratic work requirements for Medicaid recipients has been shown time and again to be of no real value. Indeed, there is significant research from another safety net program (TANF) that debunks the CMS claim that work requirements somehow lift people out of poverty. The research shows that the impact of work requirements was actually very minimal and did not reduce poverty.

What’s more, as a practical matter, such requirements are unnecessary. Research shows that 80 percent of Medicaid enrollees already belong to working households and that 60 percent are working themselves. Considering these data, it appears that states will have to deal with the administrative burden and cost of tracking adults’ working status unnecessarily. Not surprisingly, when it comes to cost and administrative burden, CMS is not planning on providing federal resources to implement or administer work requirements or other related activities.

The bottom line: Medicaid work requirements are wasteful and ineffective. If North Carolina lawmakers move forward to close the coverage gap with such a requirement appended on, it’s essential that they consider factors such as the availability of jobs or even likelihood of being able to establish skills training programs in some of the more low-resource communities in the state. All that said, lawmakers should also note that, even when it’s implemented imperfectly, Medicaid can bring jobs across the state, help families become more financially stable as they avoid medical debt, and help them stay healthy so that they can contribute to their communities.

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