Some Medicaid recipients could find themselves forced to work in order to be eligible for health-care benefits thanks to a policy paper issued today (Jan. 11).
But rather than forcing more Americans to work for their health insurance, the move—a far-right Republican goal—will either have limited reach, or push people off of Medicaid entirely.
The Trump administration initiative is “designed to assist states in their efforts to improve Medicaid enrollee health and well-being by incentivizing work and community engagement among non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability,” according to the Department of Health and Human Services paper.
Medicaid is only available to people over 65, the disabled, and the nation’s poorest people who don’t get health care any other way. The move was quickly criticized by Democrats.
“Imposing work requirements on Medicaid recipients is counterproductive and most likely illegal,” said Cedric L. Richmond, the representative from Louisiana, adding that people on Medicaid who can work are already working. “The last thing Americans who have fallen on hard times need is to lose their health care so Washington Republicans can take a political victory lap at their expense,” he said.
The change may particularly affect some 15 million Americans in 31 states and the District of Columbia who were included in the 2014 “Medicaid expansion” enacted under the Affordable Care Act, which raised the income bar to qualify. Rolling back this expansion was a key part of earlier failed Republican health care bills, as was forcing women with who gave birth more than 60 days ago off the program.
Kentucky wants to require able-bodied adults without dependents to work 20 hours a week in order to get Medicaid, and other states have considered similar requirements.
Women are the majority of Medicaid recipients. The gender gap is highest in California, where 62% of recipients are female, but they also make up 60% or more of Medicaid recipients in many southern states, including Alabama, Arkansas, and Louisiana.
The biggest group covered by Medicaid is children, who would not be forced to work under the new Trump policy.
Adding just a tiny increase in earnings could ultimately disqualify some recipients. In order to qualify for Medicaid, in many states a household’s income must already be far below the federal poverty line (which was $20,420 for a family of three in 2017).
That may be intentional. “We see people moving off of Medicaid as a good outcome,” Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, told reporters on today (Jan. 11).