Administration unveils major policy shift that could mean millions of Americans could be legally required to hold a job to be on Medicaid

This article is more than 2 years old

This article is more than 2 years old

Millions who rely on Medicaid, America’s biggest public health insurance program, could be required to have a job if they want to hold on to their coverage in the future.

The Trump administration has unveiled a major policy shift that offers a path for states seeking to tie Medicaid eligibility to work requirements.

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Seema Verma, head of the federal centers for Medicare and Medicaid services, said work and community involvement can make a positive difference to people’s health and lives. But the plan is likely to face strong political opposition and even legal challenges.

Medicaid is the nation’s largest public insurance program, providing health benefits to nearly 74 million Americans, chiefly low-income adults.

Many recipients already have jobs that don’t provide health insurance and people are not 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 seeks to allow states to apply the rules in such a way that would allow them to impose work requirements on “able-bodied” adults.

Ten states, mostly conservative ones, have applied for waivers involving requirements for jobs or community involvement for most Medicaid recipients.

Advocates for low-income people expressed dismay.

“It is a very major change in Medicaid that for the first time would allow people to be cut off for not meeting a work requirement, regardless of the hardship they may suffer,” said Judy Solomon of the Center on Budget and Policy Priorities, which advocates for poor families.

A study from the non-partisan Kaiser Family Foundation found that almost 60% of working-age adults on Medicaid are already employed. Most who are not report reasons such as illness, caring for a family member or attending college.

“People who participate in activities that increase their education and training are more likely to find sustainable employment, have higher earnings [and] a better quality of life,” Verma said.

Seema Verma was appointed to her post by Trump after serving as a senior adviser to Vice-President Mike Pence and she is known as a conservative darling who made her name as a consultant devising the Medicaid plan in his home state of Indiana, known one of the most punitive in the country.