What You Need to Know About Medicaid Work Requirements

Under a new policy from the Centers for Medicare and Medicaid Services, a government agency headed by Trump appointee Seema Verma, states will be allowed to institute work requirements for people receiving Medicaid coverage. If you’re wondering what these requirements might mean for people on Medicaid, we’ve got some answers for you.

The first thing to know is that this initiative has long been a policy priority for Republicans, who believe in instituting work requirements not just for Medicaid, but also for other social benefits programs. In the case of Medicaid, the Trump administration argues that work requirements will “improve Medicaid enrollee health and well-being through incentivizing work and community engagement.” Medicaid work requirements are also a pet cause of Verma’s.

Will Your State Institute Work Requirements?

That depends: Your state’s Medicaid Director would have to include them in a package of policies submitted to the federal government for consideration. Kentucky has already successfully done so, and at least eight other states have submitted what’s known as a “waiver” to request permission to begin instituting work requirements.

The federal policy does not mandate that all states start using work requirements.

What’s Involved?

This depends on an individual state’s specific policy, but typically, people are required to submit proof that they are working, searching for jobs or participating in an “approved training program” if they want to receive Medicaid coverage. If individuals can’t meet these standards, they will be dropped from the program.

You may have heard that people over 65, pregnant people, single parents of very young or disabled children and people with permanent disabilities would be exempt from work requirements. The disability community, which relies heavily on Medicaid for health care, is very concerned about the structure of these regulations, because not everyone who’s disabled will qualify as “permanently disabled” under this rubric — and that could force people who aren’t able to work to take up employment or risk losing their insurance.

Disability determinations can take months and may involve a lengthy legal battle at times. Conditions that are substantively disabling aren’t always viewed as such by the government; for example, someone with a serious heart condition that limits their physical activity might not be counted, or someone with severe asthma exacerbated by exercise or being outdoors would be deemed fit for work.

College students would not be exempt from these work requirements, either, which pressures people to start work immediately after high school if they want to retain Medicaid coverage. A college degree can substantially increase future earnings, and among those who are on Medicaid and unemployed, many are high school graduates — or those who never even got a diploma.

Will Work Requirements Boost Employment and Foster Economic Independence?

Proponents of work requirements argue that they will help people get off government benefits so they can live independently. But considerable research indicates that this isn’t the case.

You might be surprised to learn that the majority of Medicaid recipients are already working – many in settings where employers provide little to no insurance coverage. Eight in ten recipients live in a family where at least one person is employed. Those who aren’t working may have disabilities or other issues that make it difficult or impossible to work. And others may be providing care for family members, or may be unemployed because they cannot find work.

Also of note: Some states, like Massachusetts, allow disabled people who want to work but need Medicaid to survive to share cost, in what’s called Medicaid buy-in. This allows people who would be earning too much to be eligible for government funding — but not enough to cover the costs of their care, or the cost of insurance coverage — to shoulder part of the cost for Medicaid benefits. This lets disabled people join the workforce and be a part of society without jeopardizing their care by violating Medicaid asset and income limits.

States with Medicaid expansion programs have higher numbers of employed recipients, illustrating that the Medicaid expansion can be a form of economic empowerment. People who can access health care are more likely to get back to work quickly when injured, and to stay employed.

Health Affairs estimates that about 11 million people could be at risk of losing their coverage if the entire country adopted work requirements.

Take Action!

If you have concerns about Medicaid work requirements, you should contact your state officials to register your protest, and say you want assurances that your state will not seek a waiver allowing it to institute them. If your state has already initiated the process, pressure your officials to put the brakes on.

You can also join Care2 activists in demanding that Congress authorize funding for the Children’s Health Insurance Program, which covers nearly nine million low-income children across the United States. While CHIP recipients wouldn’t be subject to work requirements, withholding healthcare from children as an ideological bargaining chip is a a low blow.

Photo credit: TexasImpact


Marie W
Marie Wabout a year ago


John B
John Babout a year ago

Thanks for sharing.

Amanda M
Amanda Mabout a year ago

My husband and I are on Medicaid because of our income level, and WE BOTH WORK. He's a delivery driver with hopes of opening up his own sandwich/sub shop, and I'm a stay-at-home mom (yes, that is a REAL JOB!). My big question is whether or not stay-at-home parents of older kids would qualify, and with Twitler's attitude towards women, the answer is probably not. Well, guess what? There are literally NO jobs in the area that I qualify for, and those that I do involve an impossible commute with no car and no public transportation. Worse, they only pay minimum wage stuff even with me HAVING a bachelor's degree. Worse still, the only after-school care in our area is ruinously expensive AND is conservative church-based (Methodist, Baptist, or Pentecostal are the options, none of which are options for a Wiccan family). Finally, there's nobody else who can shuttle the kids to and from their activities besides me (it's complicated). Past Member, Medicaid is NOT welfare-it is HEALTH INSURANCE. BIG difference there, and I would quite literally be DEAD without expanded Medicaid. And we're not alone-there are already plenty of people who already work who are on Medicaid. There's just no way this crackers system would work. Stupid, stupid, stupid.

Past Member
.about a year ago

Glad to see the states are given this option, should have always been the case. Able-bodied welfare recipients of any kind should have work requirements.

Brian F
Brian Fabout a year ago

It would be nice if we could have Medicare for All but most of the corrupt Democrats like Nancy Pelosi refuse to support it, because they are corrupt like the Republicans.

Mary B
Mary Babout a year ago

Of course with holding medicaid by requiring work requirements WON"T WORK.Further more, these people who come up with this stupidity have forgotten that THEY work for US ! They have become TOO dependent. FIRE THEM and send then out to live the existence they think they can dump on us. Then the next time you ask why those women who were sexually abused years ago didn't report it THEN, when far too many here and now can't even remember who is supposed to be deciding what goes on now because they are looking at who has stolen our government,and our lives and our environment for their own enrichment.

Peggy B
Peggy Babout a year ago


Cathy B
Cathy Babout a year ago

Thank you for sharing.

Winn A
Winn Aabout a year ago

Petition Signed

Chrissie R
Chrissie Rabout a year ago

Thank you for posting.