The Centers for Medicare and Medicaid Services released guidelines Wednesday allowing states to implement work requirements for Medicaid.

While Medicaid enrollees would have to prove they were employed, in school, or in a job training program, there would also be exemption for the sick, elderly, pregnant women, and caretakers.

This will be the first work requirement in Medicaid's 52-year history.



The Centers for Medicaid and Medicare Services (CMS) released guidelines on Wednesday that will allow states to create rules requiring all Medicaid recipients have a job in order to gain coverage through the program.

Under the new rules states can make it so that anyone applying for Medicaid, the government program that provides healthcare to low-income Americans, must prove that are employed, in school, or in an equivalent job training program.

This would be the first time in the 52-year history of the Medicaid program that there is any sort of work requirement.

"Our policy guidance was in response to states that asked us for the flexibility they need to improve their programs and to help people in achieving greater well-being and self-sufficiency," CMS Administrator Seema Verma said in a statement announcing the guidance.

Only 6% of Medicaid recipients not working surveyed said they were unemployed because they could not find a job, according to data from the Kaiser Family Foundation, a nonpartisan health policy think tank. 36% said they were ill or disabled, 9% said they were retired, and 30% said they were taking care of family or their home.

People with a disability, pregnant women, elderly people, children, and the "medically frail" must also be exempted from the requirement, according to the new rule. The guidance also says that states should also consider "caregiving for young children or elderly family members."

Ten states — Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin — requested the ability to put the work requirements in place, according to the CMS statement. Any state wanting to add a work requirement would still have to petition the CMS.

Opponents of the proposal say that it opens up the ability for at-risk patients to get denied access and will make it more difficult for worthy recipients to get access to care.

Drew Altman, the president and CEO of the Kaiser Family Foundation, wrote in a post for Axios in April that work requirements are more a moral argument than a practical one.

"Liberals find Medicaid work requirements repugnant because they believe that Medicaid beneficiaries want to work if they can, and that providing health coverage to people who cannot afford it is an obligation of any moral nation," Altman wrote. "Conservatives who favor work requirements see Medicaid coverage as another form of government welfare benefit, like cash assistance, requiring reciprocal obligations from beneficiaries, and a disincentive to work."

In the end, Altman said, the change likely won't have a significant difference given that 59% of Medicaid recipients already work and those that don't are likely in the exempted categories.

"With most beneficiaries working or with good reasons not to be, that impact will be small," Altman concluded.