I think I’m going to make a horror movie entitled The Return of Medicaid Work Requirements.
I know it doesn’t sound very scary but believe me, this movie will be terrifying.
And I won’t even have to make anything up. My script can be about spooky stuff that’s really going on.
Our story begins in 2017, when the administration of the squatter that occupied the White House encouraged state governments to change their Medicaid rules so as to require certain adults to work or pursue employment as a condition of receiving and maintaining eligibility. Several states, including Arkansas, took up the offer.
Before I say more about the predictable disaster that ensued, let me say that Republicans in 2023 have resurrected the idea of such Medicaid work requirements in the Limit, Save, Grow Act. That’s the legislation that spells out their demands for agreeing to raise the federal debt ceiling. This bill passed the House in April with all Republican votes. This bill compels states to require certain adults between ages nineteen and fifty-five to work or participate in other qualifying activities (like community service or job training) for at least eighty hours per month in order to receive Medicaid.
If an enrollee fails to meet or properly report fulfilling these requirements for three or more months, the federal government could stop paying for their Medicaid. If the state didn’t kick that person off the Medicaid rolls, it would have to pay the entire cost of their coverage.
Let me also say that disabled people and some others are exempt from meeting the work requirements in this bill. But in actuality that doesn’t mean a thing, which brings us back to Arkansas.
This isn’t about employment at all. It’s about finding discreet, cowardly ways to shrink Medicaid.
Disabled people were exempt from that state’s work requirements, too. But merely being disabled wasn’t good enough. The Arkansas rules required disabled Medicaid recipients to reapply for that exemption every two months. This meant that by the time a disabled person proved that they were still disabled by submitting the proper documentation through the proper channels, they pretty much had to repeat the process again. This greatly increased the odds that a disabled person could have their Medicaid cut off—not because they were no longer disabled but because they couldn’t keep up with the ridiculous reporting requirements.
So it’s no wonder that during the first six months that these new rules were in place in Arkansas in 2018, more than 18,000 people were kicked off of the state Medicaid rolls.
An analysis of the Arkansas Medicaid work requirement conducted by the Center on Budget and Policy Priorities said, “Far more Arkansans are losing Medicaid coverage than are in the presumed target group of people not working and ineligible for exemptions, which means people who should remain eligible are losing coverage.”
This was all so alarming that, in 2019, a federal judge halted the new Arkansas Medicaid work requirement.
I believe the Arkansas horror story illustrates well why Republicans are so passionate about the idea of Medicaid work requirements and why they are so determined to keep them alive. This isn’t about employment at all. It’s about finding discreet, cowardly ways to shrink Medicaid. If it was up to a lot of Republicans, there would be no Medicaid at all. But they know attempting to do away with Medicaid would be so wildly unpopular that it could mean political suicide. So they’re enamored with any sneaky scheme that moves closer to that goal.
It looks like we have to slay this monster again. This time, let’s drive a stake through its heart.