The Reality of Trump’s Work Requirement Order

The White House’s most recent move to add work requirements to welfare programs may do little to alter Medicaid.

President Donald Trump looked to strengthen his administration’s plans to add work requirements to welfare programs, including Medicaid, in an executive order signed recently.

The order directs the Department of Health and Human Services and other agencies to give more flexibility to states to install work requirements in their public assistance programs, strengthen existing work requirements, and review their existing guidance and regulations to ensure they’re pushing people in these programs into employment programs.

However, one critic of the Trump administration told me the federal government has already done just about everything it can do to permit states to install work requirements in Medicaid programs across the country.

“There’s nothing more they can do; they’re already allowing the most draconian policies imaginable,” Sara Rosenbaum, a health policy professor at George Washington University who is part of a lawsuit challenging the work requirements installed by Kentucky, said.

Jeff Myers, president and chief executive officer of Medicaid Health Plans of America, told me he’s hoping the order prompts states seeking permission to install work requirements in their Medicaid programs to think more broadly about their programs serving the poor. He said many states want to combine insurance, housing and transportation programs to better tackle the issues poor people face, but they face policy barriers that prevent mixing of federal dollars for separate programs.

“An optimist could see it as a mandate from the president to think through anti-poverty programs in a far-more comprehensive manner,” he said.

After releasing the order, Trump administration officials specifically noted there are over 74 million people enrolled in Medicaid and the Children’s Health Insurance Program, an all-time high. The two programs are among the largest under the HHS, but the agency also oversees Temporary Assistance for Needy Families (TANF), which gives poor families financial aid; programs that give financial assistance to low-income families who are struggling to afford home heating costs; homelessness initiatives; and foster care programs.

The Trump administration has already started allowing states to consolidate public assistance programs into “welfare-to-work” demonstration programs, Steve Wagner, acting assistant secretary at the HHS’s Administration for Children and Families, said in a statement. The order is meant to expand on that authority, he said.

Wagner said his agency in coming months will issue new policy guidance and research on work requirements for other programs.

The Trump administration has been signaling since early 2017 its willingness to allow states to test new models in their public health insurance programs for the poor that include work requirements for beneficiaries. Three states—Arkansas, Indiana, and Kentucky—have installed work requirements for their Medicaid recipients, and seven more states have pending requests for similar requirements.

These changes are central to Republican efforts to remake Medicaid, which expanded coverage in 32 states under the Affordable Care Act, and restrict the program to those who can’t find employment because they are elderly or disabled, or are children. However, critics have noted, new requirements bring administrative burdens as well.

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