Medicaid Work Requirements Meant to Fight Poverty? Public Doesn’t Buy It

Most Americans don’t buy the argument that the primary aim of allowing states to add Medicaid work requirements is to pull more people out of poverty. Instead, more people believe the motivating goal is something else: to cut Medicaid spending by reducing enrollment in the health program for low-income Americans.

According to a poll by the Kaiser Family Foundation, just 33 percent of respondents said the primary goal of work requirements is to give people a hand up out of poverty by motivating them to find jobs, while 41 percent said it’s to whittle down the Medicaid rolls, thereby lightening the financial load for states and the federal government.

The findings suggest the public doesn’t really believe the messaging from US Health and Human Services officials who are working with states to add more enrollment requirements to Medicaid, a program whose enrollment has grown steadily in recent decades. Enrollment blossomed when many states, including Iowa, expanded Medicaid under the Affordable Care Act (ACA). Now, some states are asking the federal officials to approve waiver requests to allow them to institute requirements for Medicaid recipients for the first time.

The Iowa Legislature is considering a bill that would add work requirements to the state’s Medicaid program. A long list of Iowa health care provider and social service organizations have come out against the bill, while zero organizations are supporting it.

Seema Verma, administrator of the Centers for Medicare & Medicaid Services, has stated that work requirements will motivate low-income Americans to become more self-sufficient by finding employment: “We must allow states, who know the unique needs of their citizens, to design programs that don’t merely provide a Medicaid card but provide care that allows people to rise out of poverty and no longer need public assistance.” Likewise, HHS Secretary Alex Azar has called work requirements “a pathway out of poverty.”

The dramatic growth in Medicaid enrollment and spending has been a long-rehearsed refrain by those critical of the program. But the idea of reducing poverty makes for better messaging for both federal and state officials than simply cutting Medicaid enrollment, especially at a time when the ACA is more popular than ever.

There’s a range of ways beneficiaries could satisfy the work requirement — and there are a number of exemptions, including for the disabled and those caring for small children. But work requirements would shed some people from the Medicaid rolls simply because of the extra bureaucracy and documentation.

Yet given the fact that most Medicaid recipients who can work already do, it’s unlikely the requirements would do much to diminish state payments on Medicaid costs. Of course, placing more requirements on Medicaid enrollment and reducing government spending on the program aren’t necessarily incompatible goals. But even if it were possible to diminish Medicaid spending with work rules, it would be wrong to use them simply to drive away people from the program.