Trump Administration Will Allow Work Requirements for Medicaid

Medicaid recipients in certain states may soon have to prove employment
Breast Cancer News
January 19, 2018
Eric Fitzsimmons, Copy Editor and Content Coordinator
Reviewed By: 
Joanna L. Fawzy Morales, Esq

In a letter issued January 11, the Center for Medicareinfo-icon and Medicaidinfo-icon Services (CMS) announced its support for states to require people receiving Medicaid coverage to be working.

The announcement clears the way for 10 states that have already applied with CMS to start such programs. But states that do want to require people on Medicaid to work will face legal challenges, because some say work requirements do not support the objectives of the Medicaid program and thus can’t be allowed under current law.


Medicaid is a program that provides healthcare coverage for certain people with low income and few assets (valuable property like homes or cars). Low-income groups that must be covered by Medicaid include people with disabilities, people who are elderly, pregnant women, and children. The Patient Protection and Affordable Care Act, also known as the ACA and Obamacare, offered federal funds to states to expand Medicaid to cover more people based on income, even if they don’t have a disability or other medical need.

In most states now, anybody who earns less than a certain amount of money can get healthcare coverage through Medicaid. This has allowed people to get medical care despite financial struggles and assured payment to the hospitals and medical centers that provide them care.

Despite the benefits of expanding Medicaid, many people believe such programs cost the government too much money. And, under current law, people who qualify for Medicaid are allowed to be unemployed. Some people also believe that offering this kind of assistance encourages participants to not work. Legislators in favor of work requirements say they will result in more people on Medicaid having jobs and participating in healthy behaviors, which will be good for them and their community.  

CMS may give states permission to try new programs, like work requirements, but the law requires that any state programs continue to help the objectives of Medicaid. This is most commonly interpreted to mean new programs will continue to help people with low incomes by increasing their access to medical care or improving their health.

The January Announcement

The letter from CMS announcing their support of work requirements argues that work and community activities are good for health. “For example, higher earnings are positively correlated with longer lifespan,” the letter states. It refers to other studies that link unemployment with depressioninfo-icon, more deaths and more visits to the hospital. The conclusion from CMS is that work requirements will encourage people to work, which will be good for their health. CMS does note that states should not require people with a disability to work, but how the government defines disability relies on a person using Supplementary Security Income, which has specific requirements and can take a long time to approve.

There are many reasons why you may not be able to work. Kaiser Family Foundation reported on data about people who would be affected by a work requirement, and found that most already work and many people not working were in school (15 percent) or taking care of family (30 percent). Others would like to but haven’t found work. The largest group were 36 percent of people who reported an illness or conditioninfo-icon that keeps them from working. If you have a major illness like breast cancer, you may find that you can’t work because of long-term treatment but don’t qualify as disabled.  

According to an article in the Washington Post, states that have applied with CMS to require proof of work are: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. Kentucky’s plan was approved on January 12.

What This Means for You

If you have had to leave work or work less because of breast cancer symptoms and treatment and rely on Medicaid to make medical care affordable, you may wonder if you will be affected. A work requirement will make it more difficult for many to get healthcare coverage, but how one affects you specifically will depend a lot on your state and what CMS decides to allow each state to do.

Most states have not applied to require work and many probably will not. States that do get approval may not require you to work if you have a major illness like breast cancer or if you are a caregiverinfo-icon.

Keeping your coverage is important, especially if you are receiving breast cancer treatment. If your state installs a work requirement, prepared to provide more information to keep your Medicaid benefits. You may be asked to prove that you have work, or that you have an exception, and either can mean extra paperwork. You will also have to remember to report any changes in pay or employment status in a timely manner or risk losing your benefits.

Right now, you can call your state representatives. People speaking about their stories changed the minds of national legislators several times in 2017. If you are worried that a work requirement would affect your ability to pay for health care or properly see after your health, let your representatives know

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