No Precedent for Kentucky’s Proposed Medicaid Work Requirement

Kentucky Governor Matt Bevin has proposed a Medicaid waiver that would require adult beneficiaries without dependent children to work or volunteer at least 20 hours a week to receive their benefits.  Although the federal government has consistently rejected such proposals, the governor claims that language on the Centers for Medicare and Medicaid (CMS) website supports his proposal.  That’s not true.

Arkansas, Pennsylvania, and Utah proposed work requirements for adults who gained coverage through health reform’s Medicaid expansion.  CMS rejected all these proposals, most recently in a letter that Department of Health and Human Services Secretary Sylvia Mathews Burwell sent to Arkansas’ governor.

Gov. Bevin is conflating his work requirement with CMS’ support of the Medicaid Buy-In program, a longstanding state option that makes work possible for people with disabilities.  Under this program, Medicaid beneficiaries with disabilities who work and wind up making too much to qualify for Medicaid don’t lose its benefits, which are specifically designed for people with high health needs and in many cases make it easier for them to maintain their jobs.  The program thus doesn’t condition Medicaid coverage on work, but supports employment for a high-risk population.

As my colleague Hannah Katch recently detailed, research shows that a Medicaid work requirement wouldn’t significantly boost employment and would cause many people to lose their health coverage.  If Gov. Bevin is serious about encouraging work among Medicaid beneficiaries, he should strengthen Kentucky’s education, training, and employment programs, not create barriers to getting health care.