Arkansas was the first State to do it. As soon as the Centers for Medicare & Medicaid Services’ (CMS) gave them the green light in 2018 they introduced a work requirement as a requirement for Medicaid benefits. CMS felt that work requirements would “promote better… health” because they will increase employment and thereby improve health and well-being.” Not one of those ideas is supported by evidence. This is what they accomplished.
About 18,000 adults were bounced out of Medicaid. The rest found minimal paying jobs that didn’t last long. Within five years employment rates for those without the work requirement was the same as, if not higher, than employment rates for those subjected to work reporting requirements. Federal courts shut them down.
No other State jumped at the opportunity until Trump arrived. During his administration, 13 states were approved to move forward. Nine others had pending requests. Republicans have always loved the work requirement, even though it applies to only 7%, at most, Medicaid beneficiaries. The other 93% are either already working, too disabled to work, are pregnant, caretakers, retired or in school,
The Republicans have always had Medicaid in their AR-45 home defense sights. They see it benefiting the able bodies loafing mooching men who don’t want to work. They didn’t want Medicaid and they did their best to repeal and replace the Affordable Care Act.
Speaker McCarthy is now introducing the work requirement as a lever in the national debt ceiling crisis. The proposal was included in House Republicans’ bill to raise the debt ceiling into next year. Under the proposal, Medicaid beneficiaries ages 19 to 56 must work, volunteer or be part of a work program for 80 hours per month or participate in some combination of those activities.
The proposal allows states to keep those who do not comply with work requirements enrolled in the program, but those Any State not going along would take on the full cost ( instead of half) of coverage for those enrollees. House Republicans’ Medicaid work requirement proposal would result in an estimated 600,000 people losing coverage, the Congressional Budget Office said
Haven’t they understood from the failed Arkansas experiment that Medicaid work requirements do little for employment? All they accomplish is stripping health coverage from low-income adults including people who cannot overcome various bureaucratic hurdles to document that they either meet work requirements or qualify for an exemption from them.
And it doesn’t come without cost. We learned from a 2019 paper from the nonprofit organization Ideas42, that work requirement create a lot of new paperwork for benefit recipients. Having a job requires documentation a in a form that the government considers acceptable. Those without jobs must document hours of community service, time in a work program, or, the details of the job search.
Arkansas officials added to the challenge. They required Medicaid recipients to navigate a complicated and confusing website making it necessary to have internet access and sophisticated computer skills. If that’s not enough, complete submissions had to be entered by the fifth day of each month, and the website shut down every night from 9 p.m. to 7 a.m. Administrative costs on social service offices soar.
To summarize, Medicaid work requirements worsen health and do nothing for employment. Many entitled beneficiaries exempted from the requirements will lose their eligibility.
That may be enough to make the Republicans happy.
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