After more than half a year of speculation, on January 11, the Trump administration finally put forth a controversial new policy to allow individual states to enact work requirements for individuals currently on Medicaid. This is the first time in the half-century that Medicaid has existed that such requirements have been proposed.

Traditionally considered an entitlement program, meaning any individual can enroll as long as they meet the specified criteria, Medicaid was first signed into law by President Lyndon B. Johnson in 1965. It was designed to be a “public insurance program that provides health coverage to low-income families and individuals, including families, pregnant women, seniors, and individuals with disabilities.” The program has been jointly funded by the federal government and individual states ever since, with each state using the federal framework to create its own respective guidelines.

Two-thirds of Medicare recipients are disabled, children, or elderly, but those who qualify as such will be exempt, according to the Los Angeles Times. As pointed out in an op-ed in The Washington Post, women greatly depend on Medicaid: 31% of African-American women ages 15 to 44 are enrolled in Medicaid, as are 27% of Hispanic women. The Post also cited a study that found eligibility for the program during early childhood reduced mortality rates for black teens by more than 13%.

Medicaid is often confused with Medicare, another entitlement program, which provides health care coverage for Americans over the age of 65 and those with disabilities. (That program is funded by taxpayers or income deductions.)

Under the administration’s new recommendations, states will now be able to enact regulations that would eliminate benefits to individuals, unless they are employed, pursuing higher education, engaging as a caregiver or volunteer, or participating in other pre-approved forms of “community engagement.” Per the Trump administration and Seema Verma, the current administrator of the Centers for Medicare and Medicaid Services, the guidelines are designed to encourage “wellness.” According to The Washington Post, "The guidance cites research it says demonstrates that people who work tend to have higher incomes associated with longer life spans, while those who are unemployed are more prone to depression, 'poorer general health' and even death."

However, this move by the Trump administration can arguably be seen as an incorrect assessment or even an attack on the working poor. According to the Los Angeles Times, a Kaiser Family Foundation report found that "6 in 10 of the nearly 25 million working-age, nondisabled adults on Medicaid are already working full-time or part-time." The individuals who aren’t working typically had legitimate reason or cause (e.g. illness or taking care of family) or were also in school, retired, or couldn’t find work.

The regulations would ultimately save states money. Kentucky is projected to save $300 million over the next five years, as a direct result of an estimated 95,000 residents losing their benefits.

Thomas J. Penister of Milwaukee has been receiving Medicaid benefits for the past two years, while undergoing treatment for anxiety, according to PBS NewsHour. Penister, who is based out of Wisconsin, one of the states looking to enact work requirements, asked, “Would it be advantageous for me even to go into the workforce instead of me therapeutically transitioning to a state where I’m actually ready to perform in the workforce?”

Moreover, there is no clear criteria on what would fulfill the requirements outlined in the recommendations for the states. As stated in the official letter sent by the Department of Health and Human Services outlining the proposed changes, “States will have the flexibility to identify activities, other than employment, which promote health and wellness, and which will meet the states’ requirements for continued Medicaid eligibility.” The lack of specificity could arguably make it a challenge for those living in rural areas, who may not have a lot of options to choose from or the resources to travel to places with other options.

Adding work requirements would likely also counter progress made in the ongoing fight against the opioid epidemic. Medicaid authorizes necessary treatments and medication, and covers four out of every 10 adults with opioid dependency, according to a recent report from the Kaiser Family Foundation. Work requirements could derail individuals from seeking treatment, the Addiction Policy Forum's Mark O'Brien told Politico. "This is a disease that hijacks a person’s brain," he said. "For some people, getting treatment is a full-time job."

Ten states — all but one of which have Republican governors, the Los Angeles Times noted — are already considering enacting the recommend measures, with Kentucky having already received permission from the Trump administration to enact them.

Related: We Fact-Checked the Trump Administration's Statements About the Middle East, Medicaid, and Education Funding

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