New Medicaid Work Requirement is Misguided (Updated: 2/15/20)

On January 11, 2018 the Federal Center for Medicare and Medicaid Services (CMS) issued a new policy encouraging states to impose work requirements on Medicaid recipients.  This policy is misguided and based upon a false narrative about Medicaid recipients.  For the reasons which follow the  Mental Health Summit urges Illinois policy makers not to impose work requirements as a condition for receiving Medicaid:

  • There is substantial evidence that being employed in meaningful work improves the mental health and general health of most people, including persons with serious mental health conditions.
  • Contrary to the premise of the new CMS policy, there are not a substantial number of persons receiving Medicaid who can work yet are unwilling to do so.
  • Rather, there are substantial barriers to employment for a large number of persons on Medicaid which prevent or discourage them from obtaining and maintaining gainful employment.  Those barriers include:
    • Employment discrimination, frequently based on mental or physical handicaps or the perception of such handicaps, as well as race, religion, ethnicity, gender and sexual orientation.
    • A percentage of Medicaid recipients also are prevented from working because of discrimination based on involvement in the criminal justice system, even though the offenses involved are frequently quite minor.
    • The failure to provide supports to people with handicaps which are sometimes needed to maintain employment.
    • Eligibility requirements for Medicaid, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) discourage people from working due to fear that they will lose these necessary benefits.  This problem may worsen because current Federal policies are undermining the financial viability of the health insurance exchanges created under the Affordable Care Act.  This means that losing Medicaid will effectively deny health insurance coverage to many people.
  • Work requirements are frequently used as mechanisms to deny benefits to people who desperately need them.   Since adequate healthcare is often necessary to restore a person’s ability to work, denying Medicaid to those who do not work, makes sustained employment less likely.  This policy is, therefore, counter-productive to its stated goal.

The Mental Health Summit urges CMS and Illinois to consider policies which will actually increase the likelihood that Medicaid recipients will be employed.  These polices may include:

  • Assistance in obtaining and maintaining employment
  • Increased Federal funding for enforcement of anti-discrimination laws, particularly the Americans with Disabilities Act.
  • Support for legislation and other advocacy to reduce discrimination based upon criminal history.
  • Increased funding for supported employment programs through Medicaid waivers and other programs.

On June 29, 2018, Judge James Boasberg of the United States District Court for the District of Columbia struck down the Medicaid work requirement in Kentucky.

On February 14, 2020, the United States Court of Appeals unanimously struck down the Trump Administrations’ Medicaid work requirements.

Here is link to Kaiser Family Foundation brief on the effects on Medicaid recipients of having a work requirement

Here is a link to the new CMS policy: work requirement for medicaid

Here is a link to Mental Health America’s statement on the rule.

Here is a link to an NPR story about this new rule.

Article on Kentucky work rules

Chicago Tribune column on Medicaid work requirements

Thresholds statement on Medicaid work requirements

American Psychiatric Association statement on Medicaid work requirements

Families USA webinar on the Medicaid work requirement

Protect our Care-Illinois statement on work requirements–PoC IL Coalition Work Requirement Factsheet FINAL

Suit filed challenging legality of work requirement

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