In 2018, the Trump Administration and GOP made multiple attempts to reverse the ACA and establish federal spending caps on the Medicaid program to lower costs. These attempts were not successful; nonetheless, a number of states expanded their Medicaid programs and proposed work requirements during this time.
According to KFF, one out of five Americans receive health care through Medicaid. The program has become the country's largest source of health care coverage and accounts for 27% of state expenditures. Due to program expansion and costs, House Republicans renewed their push for work requirements over the spring during debt ceiling negotiations with Democrats. They also suggested expanding the work requirements for individuals receiving food and cash assistance through SNAP and TANF.
The Medicaid work requirement provision did not make it through negotiations; however, President Biden agreed to the expanded work requirements for food and cash support in exchange for a two-year suspension of the debt ceiling. Despite the outcome in Washington, some states are still pursuing work requirements for their Medicaid programs with special waivers.
Even though Medicaid is a jointly funded government program between the federal government and states, the states are responsible for administering it, and the Social Security Act allows them the flexibility to customize their Medicaid programs through what are referred to as Section 1115 waivers. These waivers require approval from the Secretary of Health and Human Services. They can modify eligibility requirements or forgo provisions of federal law under the condition that the projects support the goals of the Medicaid program.
States first employed Section 1115 waivers to implement work requirements in 2017 under the Trump Administration. During that time, twelve states received approval from HHS. Shortly after, the Trump Administration was sued by health care advocates and civil rights groups, rescinding the work requirement legislation in Arkansas and Kansas. Because of this, other states were also prohibited from implementing their provisions.
GA's Work Requirements
Shortly after President Biden transitioned into office, he reversed a number of other waivers that provided states approval to implement Medicaid work requirements. Georgia was one of the states impacted by the decision and sued the administration. The District Court for the Southern District of Georgia ruled in support of Georgia, citing that the administration did not consider whether reversing the waiver would cause less Medicaid coverage. Georgia has become the only state with a work requirement for Medicaid eligibility, and the state's program, Pathways to Coverage, launched at the beginning of this month.
Work requirements have once again become a topic of debate among health care professionals and government officials. Some view the requirements as barriers to health coverage that go directly against the objectives of the Medicaid program. They argue that Medicaid is designed to provide insurance, not encourage employment. However, work requirement proponents say that the program has grown far beyond its original scope, and states must control costs. At the moment, states are navigating eligibility redeterminations, and it's important that vulnerable populations remain covered. Setting the work requirement debate aside, all states should be looking for ways to improve efficiency and cost avoid in their Medicaid plans.
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