Washington Waiver Shows How Medicaid Can Support Work

Washington State is about to implement its Medicaid waiver from the federal Centers for Medicare & Medicaid Services (CMS) to expand services that help beneficiaries with significant physical or behavioral health conditions gain access to housing and employment. That waiver is a positive step forward because it will support work by giving Medicaid beneficiaries more tools to secure employment.

The move contrasts sharply with CMS’ announcement today that, in a harsh reversal of prior policy, it will let states require work as a condition of Medicaid eligibility. Rather than support work, such work requirements will do little to expand employment but, instead, will likely lead many beneficiaries to lose coverage and care, as we explain here.

These new supportive services under the Washington State waiver are voluntary, but most eligible beneficiaries will take advantage of them. The waiver provides:

• Housing stability services to improve physical and behavioral health outcomes for people experiencing homelessness or living unnecessarily in institutional care. People who have long histories of institutionalization or homelessness often need special supports — such as help finding safe, accessible, affordable housing; finding community social services; understanding their tenant rights and responsibilities; and addressing housing emergencies with landlords and property managers — to successfully manage their health and the responsibilities of living on their own.
• Supported employment services to help more people with physical disabilities, mental health conditions, and substance use disorders find a job that matches their skills and accommodates their health conditions. Most Medicaid beneficiaries who can work do so, but for those who don’t, their chronic physical and behavioral health conditions are barriers to employment. Supported employment specialists not only help people find a job but also provide ongoing supports such as helping beneficiaries communicate any special needs to their employer, prepare for career advancement, and get additional education and training necessary for sustaining employment.

Unlike CMS’ decision to allow work requirements, Washington State’s waiver shows that Medicaid can help people address their income, housing, and other life factors in ways that will improve their health outcomes.