On January 11, the Trump Administration announced it would support state efforts to impose work requirements for Medicaid, the federal program providing health coverage for disabled, elderly and low-income individuals. The announcement reversed guidance issued during the previous administration barring implementation of work requirements for the Medicaid program.
Under the new guidelines, states would be permitted to require Medicaid enrollees to participate in “community engagement activities” to receive the program’s health benefits, which, in addition to traditional work or job training, could include education, caretaking and volunteering, among other activities. States would still be required to apply for Medicaid waivers to implement these or other new program requirements, and the administration’s guidelines would exempt certain populations from participating in work requirements, such as pregnant women, disabled individuals and the elderly.
According to administration officials, states enacting work requirements for Medicaid would be able to align conditions with those already instituted for other federal safety-net programs such as the Supplemental Nutrition Assistance Program (SNAP) and the Temporary Assistance for Needy Families (TANF) program.
While NACo does not have policy on work requirements in the Medicaid program, state implementation of work requirements could impact counties in two ways. First, adding work requirements could increase administrative burdens on counties in states where Medicaid is county-administered. In these states, counties play a central role in financing and delivering Medicaid services to residents. The addition of new work requirements could also lead to higher rates of uncompensated care, and therefore increased costs, for county hospitals and governments if residents no longer qualify for health coverage through the Medicaid program and are unable to pay their medical bills.
NACo will continue to monitor the administration’s guidance and Congressional action on the Medicaid program.
For more NACo resources on the Medicaid program, please see the following links: