Natasha Thomas, Policy Intern

Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), recently announced that the federal government will allow states to add work requirements to Medicaid eligibility. Under the Obama administration, four states applied for 1115 Medicaid demonstration waivers to integrate work requirements into their Medicaid programs, but they were denied because the Obama administration argued that work requirements do not “support the objectives of the Medicaid program.”

Currently, CMS is considering 1115 waiver requests from Kentucky, Indiana, Arkansas, Utah, and Maine that include work requirement provisions. In addition, some states have proposed other provisions to Medicaid enrollment such as charging monthly premiums (Indiana), drug testing enrollees (Wisconsin), and putting a time limit on coverage (Arizona).

Supporters of Medicaid work requirements claim they will reduce reliance on public programs by providing a pathway out of poverty, creating a culture of work and ultimately improving people’s health. Opponents of the work requirements argue that only a small fraction of Medicaid recipients that are able are not working, such a policy would hurt only the most vulnerable of society, and these changes are an effort to arbitrarily reduce the number of Medicaid beneficiaries. Statistically, 87% of Medicaid recipients are already either working, in school, or looking for work.

Health Affairs estimates that about 11 million Medicaid enrollees would be at risk of losing coverage if work requirements were imposed. Of those 11 million, about 46% have serious health problems that don’t qualify them for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), but greatly affect their ability to work. Economically, the costs for monitoring enrollees’ work activities and providing job training programs could overwhelm state and federal resources. President Donald Trump’s budget proposes funding cuts for job training programs, such as JobCorps, which would only further strain these resources.

According to the 2017 Colorado Health Access Survey (CHAS), nearly 1.1 million Coloradans receive health coverage from Health First Colorado (HFC), the state’s Medicaid program. Of those covered by HFC, 84.4% are employed or actively seeking work. The majority of employed Coloradans on Medicaid work 40+ hours a week (40.2%). If Colorado were to jump on the work requirements bandwagon, we would be wasting time, money, and resources on the mere 15.6% of HFC enrollees who are not working. In addition, this small population is likely facing health-related issues that hinder their ability to work, but aren’t enough to qualify them for benefits such as SSI or SSDI. Including a work requirement provision into HFC would cause this vulnerable population to lose what little help they have, thereby perpetuating their health issues and inability to work.

Instead, policymakers should be focusing on the fact that despite being employed and working up to and over a regular work week, hundreds of thousands of Coloradans are still unable to get far enough above the federal poverty level (FPL) to move from Medicaid to private insurance.

Read here for more from consumer perspectives and here for 1115 Demonstration waiver requests by states.

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