The Biden administration has rescinded permissions for Michigan and Wisconsin to require Medicaid beneficiaries to either work or attend school or job training in order to enroll in the public health program for lower-income Americans.
The administration’s actions follow recissions of similar requirements in Arkansas and New Hampshire.
The Trump administration embraced the idea of requiring Medicaid beneficiaries to work, prompting a number of Republican-leaning states to apply for permission to impose such requirements in their Medicaid programs. Under President Donald Trump, the Centers for Medicare and Medicaid Services granted permission to 12 states. Seven others are still waiting for a decision, although the chances of approval by the new administration are unlikely.
Even states that received approval have not enforced work requirements, because federal courts invalidated the rules. Arkansas is asking the U.S. Supreme Court to reverse lower court rulings and allow it to resume implementation of the requirement. The court could decide the issue is moot now because of the Biden administration’s objections.
Both Michigan and Wisconsin’s Democratic governors opposed the requirements, which they inherited from previous Republican administrations.
Seema Verma, CMS administrator under Trump, was a fierce proponent of work requirements. She argued that incentivizing work made sense because employment has a beneficial impact on health. She also made clear her aversion to dependence on safety net programs.
“It is not compassionate to trap people on government programs or create greater dependency on public assistance as we expand programs like Medicaid," she said in a 2018 speech.
In its letters to Michigan and Wisconsin this week, CMS said work requirements were not consistent with the objectives of Medicaid to provide medical care to the nation’s vulnerable and low-income populations, particularly during a pandemic when job losses have been high.
CMS noted that all but a small minority of Medicaid beneficiaries already work or are ill or disabled and therefore would be eligible for exemptions from the requirement.
According to one study in Michigan, CMS said, “Nearly everyone who was targeted by the community engagement requirement in Michigan already met the requirement or was exempt from it, so there was little margin for the program to increase work or community engagement among beneficiaries.”
CMS also asserted that confusion and difficulty in submitting the proper documentation could cause the disenrollment of many who would otherwise be eligible for Medicaid.