CMS Will Let States Cut Medicaid for People Who Can’t Work

For the first time, states will be able to require work or work-related activities as a condition of Medicaid eligibility, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma recently announced. Verma’s announcement followed a CMS change to the criteria for approving state Medicaid demonstration projects, known as waivers: they’ll no longer have to increase and strengthen coverage, but instead can “promote upward mobility”— a euphemism for work requirements.

Taking away health coverage won’t help people find and hold a job, research shows. Tying eligibility for Medicaid to work or work-related activities would likely mainly harm people who can’t work or can’t find work, leaving them without coverage, but it would likely affect coverage for some working beneficiaries, too:

• Most Medicaid beneficiaries who can work are already working or looking for work. Most low-income adults enrolled in Medicaid already work, and the overwhelming majority — nearly 8 in 10 non-disabled adults with Medicaid coverage — live in working families. Medicaid helps these adults keep their job or search for work. Even so, a work requirement could threaten coverage for some beneficiaries even though they’re working if they can’t meet complex administrative requirements to prove they’re working enough hours.
• Requiring work as a condition of Medicaid coverage would likely harm those who can’t work. The new CMS policy is grounded in the deeply flawed premise that Medicaid beneficiaries will find work if their Medicaid eligibility depends on it. However, more than one-third of Medicaid beneficiaries who aren’t working report that illness or a disability is the main reason, 28 percent report that they’re taking care of home or family, and 18 percent are in school. For these beneficiaries, a work requirement won’t likely help them find and keep a job — and losing Medicaid coverage won’t improve their economic mobility.
• Harming those who can’t work would violate Medicaid’s core mission, which is to provide comprehensive health coverage to low-income people so they can get the health care they need. CMS has the authority to waive sections of federal Medicaid law when necessary to implement demonstration projects that promote Medicaid’s objectives. Limiting access to care is not an appropriate use of that authority.

Rather than undermining Medicaid through waivers that will prevent people from getting the care they need, CMS should work with states to invest in evidence-based employment services that help people find and hold jobs, while preserving their access to care.