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Cara Stewart, a legal advocate opposing Medicaid work requirements, comforts Pauline Creech in Covington, Kentucky on January 15, 2018. Creech is concerned that, between her disability and her frequent doctor's appointments for cancer treatments, she won't be able to meet the work requirement of 80 hours per month. (Photo: Carolyn Van Houten/The Washington Post via Getty Images)

Cara Stewart, a legal advocate opposing Medicaid work requirements, comforts Pauline Creech in Covington, Kentucky on January 15, 2018. Creech is concerned that, between her disability and her frequent doctor's appointments for cancer treatments, she won't be able to meet the work requirement of 80 hours per month. (Photo: Carolyn Van Houten/The Washington Post via Getty Images)

Biden Urged to Withdraw All Medicaid Work Requirements Approved by Trump

Policies to "take Medicaid coverage away from people who don't comply with stringent work requirements... are deeply harmful."

Kenny Stancil

While the White House in recent weeks has taken steps to overturn a Trump-era initiative enabling states to restrict Medicaid eligibility by imposing punitive work requirements, healthcare advocates on Monday urged President Joe Biden to rescind all Medicaid work requirement policies approved by his predecessor.

"Uninsurance rates among people subject to the work requirement rose, but their employment rates didn't."
—Jennifer Wagner, CBPP

In 2018, Seema Verma, then-director of the Centers for Medicare and Medicaid Services under former President Donald Trump, issued guidance allowing states to apply for a waiver to significantly alter eligibility requirements for Medicaid, a Great Society-era program on which more than 72 million low-income adults, people with disabilities, and children rely for health insurance.

Several Republican-led states quickly jumped at the offer to strip healthcare away from poor and vulnerable Americans, and the Trump administration ultimately approved policies to "take Medicaid coverage away from people who don't comply with stringent work requirements" in 13 states, as Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities (CBPP), noted Monday in a blog post.

While litigation and the coronavirus pandemic have put the implementation of work requirement policies "on hold," Wagner stressed that "taking coverage away from enrollees or otherwise conditioning coverage on meeting a work requirement doesn't further Medicaid's purposes," which exists to provide healthcare to the impoverished. "Accordingly," she added, "the Biden administration should now withdraw all of the previous approvals."

The White House in February invalidated the previous administration's guidance allowing states to apply for Medicaid eligibility restriction waivers and notified states that had already been given permission to impose work requirements that the policies would soon be reversed due to the detrimental impact of coverage loss on Medicaid recipients, particularly during the pandemic, as Common Dreams reported at the time.

Last month, the Biden administration told Medicaid officials in New Hampshire and Arkansas—which was the first and only state to fully implement Medicaid work requirements, taking healthcare away from at least 18,000 people over a period of several months in 2018—that approval for their work requirement policies had been rescinded.

While "GeorgiaIndianaNebraskaOhioSouth Carolina, and Utah have objected" to Biden's efforts to dismantle Medicaid work requirements, Wagner reiterated that "the administration should nevertheless continue with its plan."

"These policies inevitably lead to eligible enrollees losing coverage—work requirements can't be fixed."
—Wagner

Wagner continued: "The Trump administration claimed that requiring work or other activities as a condition of coverage would 'improve beneficiaries' health,' ignoring evidence from other programs suggesting these restrictions would significantly harm Medicaid enrollees. After states began implementing these policies, their experiences confirmed the harmful effects of work requirements."

Citing a new analysis from the Department of Health and Human Services, Wagner wrote that "these policies are deeply harmful to Medicaid enrollees and confirms that they don't promote Medicaid's objectives."

Referring to the 18,000 Arkansas residents who lost Medicaid coverage in 2018, Wagner said that "uninsurance rates among people subject to the work requirement rose, but their employment rates didn't."

Arkansans "who lost coverage were more likely to have chronic conditions, and many had difficulty paying their medical bills and accessing healthcare and medications," she continued. "Data from New Hampshire and Michigan also show a significant loss of coverage would have occurred if the states' work requirement policies had been implemented, largely due to enrollees' limited awareness of the policies and challenges in reporting compliance."

"The evidence of the detrimental impact of work requirements from Arkansas, New Hampshire, and Michigan demonstrates that other state policies would face the same challenges and harmful consequences," she added. "All policies that take away coverage from people not meeting work requirements are marred by complex rules about who is exempt and what activities count, challenges communicating with enrollees, and burdensome paperwork and reporting requirements. These policies inevitably lead to eligible enrollees losing coverage—work requirements can't be fixed."

According to Wagner, "There's nothing left to demonstrate by letting more states take risks with Medicaid enrollees' health. The Centers for Medicare and Medicaid Services should withdraw all waiver authority for policies that take coverage away from people not meeting work requirements or otherwise condition coverage or benefits on meeting them and make clear that these policies won't be allowed in Medicaid."


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