Policy & Research

Share

States Move to Implement Medicaid Work Requirements (July 2018)

For the first time, beneficiaries in some states may be required to work as a condition for continued Medicaid coverage

By Linda J. Sheppard, J.D., Lawrence John Panas, Ph.D. | July 31, 2018

States Move to Implement Medicaid Work Requirements (July 2018)

READ IT HERE — Issue Brief: States Move to Implement Medicaid Work Requirements (July 2018)

KHI also has compiled the most comprehensive and up-to-date summary of all state-level activity related to Medicaid work requirements: Medicaid Work Requirements Enacted or Proposed, A State-by-State Analysis (July 2018)

In January 2018, the Trump Administration officially signaled its willingness to approve the implementation of work requirements in the Medicaid program. The Centers for Medicare and Medicaid Services (CMS) sent a letter to all state Medicaid directors providing policy guidelines for submitting Section 1115 demonstration proposals to implement work or community engagement requirements — such as community service, education and job training — for some adult enrollees as a condition for continued Medicaid eligibility or coverage. As a result, states now have a new Medicaid eligibility option, based on Section 1115 of the Social Security Act, that previous administrations, both Republican and Democratic, were unwilling to approve. 

Key points from the brief include:

  • In January 2018, the federal government officially signaled its willingness to approve the implementation of work or community engagement requirements in the Medicaid program. 
  • Since January, Medicaid work requirements have been approved for four expansion states: Arkansas, Indiana, Kentucky and New Hampshire.
  • Most proposals to implement work requirements apply to able-bodied adult enrollees, age 19-64, but states have also identified a number of exempted populations.
  • States have proposed requiring either traditional work or community engagement activities, such as job training, education or community service. 
  • A federal court voided CMS approval of Kentucky’s work requirements program on June 29, 2018.
  • CMS has expressed concerns about the implementation of work requirements in states that have not expanded Medicaid.
  • The KanCare work requirements proposal was submitted to CMS in December 2017 and is awaiting approval.
  • A recent survey found that, of Kansans currently enrolled in Medicaid or uninsured and presumably eligible for Medicaid if it were expanded, 49 percent said they were already working, another 34 percent had a disability that prevented them from working, and 17 percent were otherwise not working.

The Kansas Health Institute supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.