Trump’s Medicaid Work Requirements: Meet Real Life


January 12, 2018

“There’s a stereotype that disability recipients don’t want to work. The reality is very different.”

On Jan. 10, the Washington Post published a piece highlighting five Americans who receive federal disability benefits; the quote above is from that piece. Many of the people highlighted in the story talk about how they would like to work, or work more than they currently are, but how their disabilities keep them from being able to do so. Please read this story by reporter Kayla Epstein. The people she portrays display remarkable courage in struggling against illness, and when their determination is supported by stable health care and income support, they are more likely to be able to work.

The following day, the Trump administration moved to allow states to impose work requirements for Medicaid recipients. A letter sent to state Medicaid directors laid out the shift in policy, which gives states the opportunity to apply for waivers to allow them to establish work requirements for adult Medicaid recipients to be eligible for health coverage.

Medicaid work requirementsThere are many, many problems with adding work requirements to Medicaid. For starters, most Medicaid recipients already work. But according to the Kaiser Family Foundation, among adult Medicaid recipients who aren’t working, most report major impediments to their ability to work. Under the guidance from the Trump administration, poor adults who have disabilities as defined under Medicaid guidelines will not be subjected to work requirements. But federal disability eligibility criteria are extremely strict, and it can take years to qualify. Many people can have a disability that creates barriers to their ability to work, or to work full-time, while still being considered “not disabled enough” to qualify for an exemption from possible work requirements. In the KFF data, for example, more than one-third of adult unemployed Medicaid recipients who were considered “non-disabled” for Medicaid purposes reported that illness or disability was the primary for not working. That’s more than 3.5 million people.

Another study from Michigan found similar results. As reported by Vox, of the adults who enrolled as part of the state’s Medicaid expansion under the Affordable Care Act and who were not working but also not considered officially unable to work,

    • two-thirds said they had a chronic physical illness
    • 35 percent said they had been diagnosed with a mental illness
    • one-quarter said they had a physical or mental condition that interfered with their ability to function at least half the time.

The Washington Post piece, and many other articles and studies, show that most people want to work. For those with mental or physical health problems, access to health care coverage is essential. But the new guidance from the Trump administration could lead to countless Americans losing that critical coverage because their condition prevents them from working, or from working full-time, even if they are considered “not disabled enough” to meet strict federal criteria.

Dr. Renuka Tipirneni, the lead author of the study, put it this way:

“Even if they don’t meet federal disability criteria, our survey shows many of these individuals face significant health challenges. It’s also important to consider that dropping them from coverage for failure to fulfill a work requirement could seriously impact their ability to receive care for chronic physical and mental health conditions that can worsen without treatment.”

Access to medical care is critical to keeping people healthy, which allows them to work as they are able. To learn more about Medicaid work requirement proposals being tracked in the states, click here. For statements, infographics and other resources related to work requirements, check out CHN’s Protecting Basic Needs Programs webpage.

Affordable Care Act
Labor and Employment
work requirements