Medicaid benefits are granted based on financial need.[¹] Medicaid’s free health insurance for low income people, including those with disabilities and seniors, is provided to nearly 75 million people: a quarter of all Americans.[²] This program is and has been under threat by the Trump administration, which has approved State applications for Medicaid work requirements for the first time since Medicaid was founded in the 1960s.[³]  The Administration states this will help lift people out of poverty by compelling them to work,[⁴] but these work requirements — along with States converting Medicaid to block grants (or other waivers) and making moves to eliminate it and up to 90 days retroactive Medicaid — effectively shrink the ability of people with limited incomes to access medical care.  Fortunately, federal courts have so far rejected these work requirement impediments to Medicaid coverage.[⁵]

Medicaid Work Requirements

In the Trump administration’s 2020 budget, the government has proposed to slash $1.5 trillion from Medicaid spending.[⁶] The Administration began approving Medicaid state work requirements in January 2018 for the first time in Medicaid’s history.[⁷]

Indiana released and then recently suspended its Medicaid work requirements after being sued by advocates who successfully got work requirements struck down in other states.[⁸]  Medicaid work requirements have been struck down in federal courts that have seen similar cases from Arkansas, Kentucky and New Hampshire.[⁹]

“Arkansas is the only state to have taken coverage away from people for not meeting work requirements,” and New Hampshire nearly did.[¹⁰]. Arkansas had over 18,000 people (approximately 25% of those with work requirements) lose their coverage in seven months.[¹¹]

In the case of Arkansas, a Harvard research study found that their “work requirement increased uninsured rates without increasing employment . . . . [and] data show that only a small minority of those who lost coverage . . . . found jobs, and most of them would likely have found jobs” regardless of the work requirement.[¹²]

Moves to Eliminate Retroactive Medicaid

One of the ways Medicaid fulfills its mission is by providing retroactive coverage of health care received prior to application/enrollment in Medicaid, often limited to 90 days, however some states are trying to eliminate this protection.[¹³] It is important to note that retroactive Medicaid is still available to counties and states for those who get SSI-based Medicaid from the date of the SSI application, which could take a few years for approval; e.g., by a US Administrative Law Judge.

Block Grants to States

Under a block grant system, states would be given an annual lump sum to distribute to Medicaid recipients while reserving the right to impose restrictions such as personal spending caps and exempting the state itself from federal Medicaid policies that ensure coverage for its neediest residents.[¹⁴] These block grants may get struck down by the courts, because any state changes to the Medicaid framework must “promote Medicaid’s core purpose of helping low-income Americans get access to necessary medical care.”[¹⁵]

These state-based attacks on the integrity of Medicaid keep coming. “[P]eople with disabilities were particularly vulnerable to losing coverage under the Arkansas work and reporting requirements, despite remaining eligible.”[¹⁶]  Nor do work requirements provide their intended purpose of Medicaid recipients finding new work and they often take “coverage away from people who are already working or should be exempt.”[¹⁷]