Trump makes the right move in taking us one step closer to Medicaid work requirements

Trump makes the right move in taking us one step closer to Medicaid work requirements
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On Tuesday, the Trump administration reaffirmed its commitment to move millions of able-bodied adults from welfare to work. Seema Verma — head of the Centers for Medicare and Medicaid services — promised that the administration will approve Medicaid reforms “that promote community engagement and work activities.”

Such a promise could not come at a better time. As forthcoming research by the Foundation for Government Accountability shows, Medicaid spending and enrollment has skyrocketed in recent years, crowding out resources for other critical priorities. Nowhere is this growth more evident than among able-bodied adults. Nearly 28 million able-bodied adults are now dependent on the program, up from fewer than seven million in 2000. This enrollment explosion is fueling a massive spending surge. Total Medicaid spending has nearly tripled since 2000 and spending on able-bodied adults has increased by a jaw-dropping 700 percent. In some states, Medicaid now consumes more than half of their operating budgets.

The implications of this Medicaid explosion are clear: fewer dollars are available for truly vulnerable individuals who depend on the Medicaid program to survive. Fewer dollars are available for important budget priorities like education, public safety, and infrastructure. And there’s no end in sight. 


The status quo is unsustainable and unacceptable. Commonsense work requirements will not only reduce dependency, but also improve the lives of individuals currently stuck in the Medicaid program. These requirements have been wildly successful in other major welfare programs at reducing dependency, increasing incomes, and freeing up resources for those in need. And as Administrator Verma explained, “meaningful work is essential to beneficiaries’ economic self-sufficiency, self-esteem, well-being, and health.”


Five states — Arkansas, Indiana, Kentucky, Maine, and Wisconsin — already have waivers pending with the Trump administration to implement common-sense work requirements for able-bodied adults on Medicaid. Another four states — Arizona, Kansas, New Hampshire, and Ohio — will be submitting their waivers soon. And policymakers in at least 18 additional states have signaled that they, too, would like to bring work requirements to Medicaid. 

Verma’s promise to consider such waivers is a critical step forward for Medicaid reform. Under federal law, the administration can approve any such request that the Secretary determines “is likely to assist in promoting the objectives of the program.” One such objective under the Medicaid statute is to “help such families and individuals attain or retain capability for independence.” And work is the only meaningful way for families and individuals to attain independence.

Unfortunately, few able-bodied adults on Medicaid work full-time jobs and most don’t work at all, according to a forthcoming analysis by the Foundation for Government Accountability. It’s even worse among ObamaCare expansion enrollees — in some states, up to 60 percent of expansion enrollees have no earned income. Moving these adults out of dependency and back into the workforce is critical to improving their lives and filling the more than six million open jobs across the country.   

These waivers will advance a core objective of the Medicaid program and bring Medicaid into the 21st century by realigning it with other major welfare programs. States already retain the option to remove able-bodied adults from Medicaid if they’re also enrolled in cash assistance and refuse to meet that program’s work requirement. Medicaid work requirement waivers will simply expand that policy to a larger group of able-bodied adults and could usher millions back to work.

The Trump administration reaffirmed its commitment to moving Americans from welfare to work. With five state waivers already pending, the only question left is which state will get approval first.

Jonathan Ingram (@IngramLaw) is vice president of research at the Foundation for Government Accountability (@TheFGA), a non-profit research organization dedicated to replacing failed health and welfare programs nationwide.