Why are 28 million able-bodied adults on Medicaid? Expanded work requirements could help fix that


Medicaid has made major headlines over the last year and for good reason. The welfare program originally intended to provide medical assistance to poor children, seniors and individuals with disabilities has expanded to include more and more able-bodied adults.

A program initially intended for the truly needy now covers 28 million able-bodied adults and costs taxpayers more than $500 billion a year.

Fortunately, the Trump administration has now taken a commonsense step towards reforming Medicaid. Earlier this year the Centers for Medicare and Medicaid Services released new guidance encouraging states to require work or job training for able-bodied adults as a condition of Medicaid eligibility.

By modernizing the Medicaid program through state waivers that would expand work requirements to able-bodied adults, states are simply trying to improve their Medicaid programs. The states are also targeting benefits to people most in need, including seniors, poor children and individuals with disabilities.

And by targeting able-bodied adults, many of whom have joined Medicaid since the program’s expansion under ObamaCare, the reforms will help encourage independence and self-sufficiency – one of the primary objectives of Medicaid.

Research has shown that previous efforts to require work for able-bodied adults have lifted people out of poverty by increasing total income. The new guidance is also designed to promote better health – another key objective of the program – and to drive better health outcomes.

Work requirements are a reasonable and commonsense approach to helping able-bodied Medicaid beneficiaries move out of dependency and back into the workforce, either through work or preparation for a job.

There’s a growing body of evidence showing a strong correlation between employment and health. Higher earnings – which work provides over welfare – correlate with longer lifespans. In addition, and researchers in Britain found that work is good for health and well-being.

Furthermore, reductions in welfare caseloads from the 1996 reforms were associated with reduced binge drinking and increased physical activity.

Despite the headlines, the guidance’s actual policy thrust is surprisingly modest. Work requirements will only apply to able-bodied adults. Seniors, children, pregnant women, individuals with disabilities, and others physically or mentally unfit for employment will be exempt altogether.

In addition, able-bodied adults will have a myriad of ways to meet the new requirement: through work, job training, volunteering, or even by seeking treatment for addiction when applicable.

Democratic and Republican governors alike are already pursuing this commonsense reform.

The new guidance will help those states realign Medicaid with other major welfare programs – including food stamps and cash assistance that have successfully used work requirements for decades. This will help states design programs that work better for the people they serve and protect funding targeted to those most in need.

Policy, rather than politics, is driving welfare reform – but it’s also important to note that this guidance accords with Americans’ own views of the Medicaid program. A Heritage Foundation poll last year found that 92 percent of respondents support commonsense Medicaid work requirements.

This guidance starts the process of getting Medicaid back on track. Looking at the facts rather than scary headlines, it’s clear that it has been narrowly tailored to focus on able-bodied adults and that the Department of Health and Human Services will monitor implementation closely to ensure the guidance is followed.

Work requirements are a reasonable and commonsense approach to helping able-bodied Medicaid beneficiaries move out of dependency and back into the workforce, either through work or preparation for a job.

States facing pressures on their Medicaid budgets – meaning every state – would be well- advised to apply for these waivers, so that Medicaid funding may be concentrated on those truly in need and so that those who are able to work will enjoy better health. 

Paul Winfree formerly served as deputy director of the Domestic Policy Council in the Trump administration.



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