In a major policy shift that could affect millions of low-income people, the Trump administration said Thursday it's offering a path for states that want to seek work requirements on Medicaid recipients. The AP reports the plan will likely face strong political opposition and even legal challenges over concerns people would lose coverage. Medicaid is a federal-state collaboration covering more than 70 million people, or about 1 in 5 Americans. People aren't legally required to hold a job to be on Medicaid, but states traditionally can seek federal waivers to test new ideas for the program. The administration's latest action spells out safeguards that states should consider to obtain federal approval for waivers imposing work requirements on "able-bodied" adults.
Those safeguards include exempting pregnant women, disabled people, and the elderly, and taking into account hardships for people in areas with high employment, or for people who care for relatives. Technically, the waivers would be "demonstration projects." In practical terms, they would represent new requirements for beneficiaries. Ten states have applied for waivers involving work requirements or community involvement: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin. A study from the Kaiser Family Foundation found that a surprising number of working-age adults on Medicaid are employed. Nearly 60% work either full time or part time, mainly for employers that don't offer health insurance. Most who aren't report reasons such as illness, caring for a family member, or going to school.