More states are looking at work requirements for Medicaid

Despite legal hang-ups in the roll out of new Medicaid work requirements, more states are taking action to potentially implement their own programs. 

South Dakota recently applied for a waiver with CMS to develop work requirements for some Medicaid beneficiaries in the state, including parents and caretakers. The Trump administration announced at the start of 2018 that it would begin accepting waivers for work requirements. So far, only four states have had these waivers approved—Arkansas, Kentucky, New Hampshire and Indiana. Kentucky’s plan, however, was blocked by a judge in June.

South Dakota’s proposal would require beneficiaries who are parents between the ages of 19 and 59 within the parent and caretaker eligibility group of Minnehaha and Pennington counties to work a minimum of 80 hours per month, take classes or follow other directives to maintain coverage.

“The plan includes a variety of activities that count toward the work requirement,” the waiver application reads. “With this approach, individuals that make a good faith effort and participate actively in qualifying activities outlined in their individualized plan will maintain coverage.”


As more states put forth waivers, the overall concept of adding work requirements to Medicaid faces numerous challenges. In addition to Kentucky's setback, HHS is facing a lawsuit from the National Health Law Program.

Within states that have managed to implement the new requirements, the first few months have not been smooth. In Arkansas, which began work reporting requirements in June, thousands of Medicaid beneficiaries failed to follow the reporting standards, and up to 5,000 are at risk of losing coverage in the coming weeks and months.

Critics of Medicaid work requirements argue the rules put some of the nation’s most vulnerable populations at high risk of losing healthcare coverage.

Like Arkansas, South Dakota beneficiaries could lose coverage if they don’t meet the requirements for three months in a year. Approximately 1,300 individuals will be enrolled in South Dakota’s work program, called Career Connector. The state also estimates that 15 percent of participants will become ineligible for benefits due to higher income levels needed to keep coverage or by choosing not to participate in the work reporting requirements.

Beyond South Dakota, Mississippi and Maine both have pending work requirement waiver awaiting approval. Maine has also proposed several other changes to Medicaid in the past, including adding a monthly premium based on income brackets, charging MaineCare member for missed appointments, ceasing retroactive coverage and more.

Banning work requirements

While more states are applying for work requirement waivers, California is looking to outlaw the practice altogether. The California state senate and assembly both approved legislation to ban Medicaid work requirements, and the bill, authored by Sen. Ed Hernandez, OD, will head to Gov. Jerry Brown’s desk to be signed into law.

“With the approval of SB 1108 by the California State Legislature, we are close to banning Medicaid work requirements in our state. If this bill is approved by the Governor, California would be the first state in the nation to stand against Trump’s effort to take Medi-Cal coverage away from those who need it most,” Hernandez said in a statement

State lawmakers also called the Trump administration’s new tact on Medicaid eligibility “mean-spirited.” The bill was sponsored by the Western Center on Law and Poverty, an advocacy organization for low-income Californians.

“California rejects the Trump administration’s attempt to add work requirements and other hurdles just to knock people of their health care,” said Jen Flory with the Western Center on Law and Poverty. “SB 1108 makes absolutely clear that the purpose of our Medi-Cal program is to help low-income Californians who can’t afford the cost of care. We urge Governor Brown to reaffirm our commitment to the Affordable Care Act and sign this bill.”