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Biden Administration Moves to Eliminate Medicaid Work Requirement Rules

Advocate Masthead

ACP opposes work requirements, saying they increase the number of uninsured

April 2, 2021 (ACP) – The American College of Physicians is in favor of recent moves by the Biden administration to eliminate work requirements for recipients of Medicaid.

ACP has firmly opposed implementing work or job search requirements because they're likely to boost the number of patients without insurance. “The more difficult it is to apply for and keep coverage, the less likely an enrollee will want to deal with the Medicaid program, leading to an increase in the number of uninsured,” said Ryan Crowley, ACP senior associate of health policy. “The mandates are costly and complicated to implement.”

In 2018, the Trump administration announced it would let states implement work requirements for Medicaid recipients. The administration argued that the work requirements would encourage Medicaid enrollees to seek employment that provided job-based health insurance.

Despite opposition from ACP and other advocates, 23 states sought Medicaid waivers that would require enrollees to work, volunteer, go to school or be otherwise engaged in the community if they wanted to enroll in or maintain their Medicaid coverage. “Thirteen of these waivers were approved, and four were blocked by the courts,” Crowley said. “The rest are pending or were rejected by the state after they were approved. Arkansas' work requirement waiver was the first to go into effect. It was eventually blocked by a federal court, but not before more than 18,000 people lost coverage due to noncompliance.”

ACP opposed the policy and developed a Chapter Action Plan to help state chapters lobby legislators to protect patients. As Crowley noted, many Medicaid recipients are already working or live with family members who have jobs. Indeed, nearly 80 percent of nonelderly adults with Medicaid coverage live in a working household, according to the Kaiser Family Foundation, and 60 percent of nonelderly adults who are Medicaid beneficiaries are already working.

“If they're not working, they usually have a valid reason – they may be taking care of a loved one, in school, retired or they can't find work,” Crowley said. “So, work requirements may be a solution searching for a problem.”

In addition, Crowley said, “Evidence also shows that work requirements don't lead to substantially higher employment among the target population or higher enrollment in job-based coverage. So, the requirements don't achieve what they set out to do.”

The work mandates are problematic in other ways. “They're a burden for physicians who will have to sign paperwork if their patients want an exemption,” Crowley said. “No one needs extra paperwork – neither physicians nor their patients.”

So far, the Biden administration has rescinded state guidance on work requirement waivers, and the Centers for Medicare and Medicaid Services sent letters to Arkansas and New Hampshire officials informing them that the federal government had formally removed permission for states to implement work requirements.

Meanwhile, the U.S. Supreme Court was scheduled to hear arguments on an appeal to block Arkansas' and New Hampshire's work requirement waivers, but the court decided not to hear oral arguments following a request from the acting solicitor general.

ACP has played an important role. “We sent a set of recommendations to the Biden transition team that included a call to withdraw work requirement guidance and waivers,” Crowley said. “The College also participated in an amicus brief supporting a federal court of appeals decision to block state work requirements.”

The Supreme Court decision could mean that Medicaid work requirements are moot, at least for now. “Every eliminated barrier to care is a victory,” Crowley said. “We're proud to have been part of this process.”

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Back to the April 2, 2021 issue of ACP Advocate