Today the Trump Administration released guidance to states to design new eligibility requirements for nondisabled Medicaid recipients which would require them to work, seek employment, or engage in unpaid volunteer services. Medicaid’s mission is to provide comprehensive health coverage to individuals with low incomes and in the 50-year history of the program, this would be an unprecedented change in a program that has been based on largely on income. The guidance exempts some populations (elderly individuals and pregnant women) and drug treatment would be counted toward a work requirement—a nod to the opioid epidemic.
Medicaid is administered by both the federal government and states. Under the Affordable Care Act (ACA), 32 states expanded their Medicaid programs, covering millions of Americans who could not access health insurance before. Work requirements on a national scale would have to be approved by Congress, however states can submit waivers to impose their own work requirements. The Obama Administration rejected such proposals but based on this guidance it is anticipated that the Trump Administration will approve them and ten states currently have such proposals pending.
Proponents of work requirements believe that they incentive work among low-income populations and that work leads to better health. However, arguments have been made that healthier people are more likely to work and not the other way around. Ultimately, proponents believe that this mandate will help people transition off of Medicaid. However, research has shown that 8 in 10 Medicaid recipients live in working families and the majority are working themselves. Many others are unable to work, cannot find work, or are at a point where they cannot work.
For cancer patients, these requirements are frightening. There are a host of reasons why patients may not be able to work and the potential of losing Medicaid coverage would be devastating. Many patients will not meet the strict federal disability requirement but may be too physically ill or suffer from mental health conditions that pose serious barriers to employment. Ultimately work requirements could reduce access to health care, making it even more challenging for some people to work.
Waivers could be approved as soon as this week, but legal challenges are expected. Make sure you sign up to be a Cancer Support Community grassroots advocate to receive timely updates on policy issues that could impact cancer patients, survivors, and their loved ones!