Trump administration’s stance on work requirements could spur more states to expand Medicaid

Filling out job application
The Obama administration generally opposed work requirements for Medicaid, but the Trump administration has embraced them. (Getty/AndreyPopov)

The Trump administration’s position on Medicaid work requirements might lead some conservative states to embrace a key component of the Affordable Care Act.

Take Utah, where both a Republican lawmaker and a spokesman for Gov. Gary Herbert told the Associated Press that the administration’s willingness to approve work requirements bodes well for the possibility that the state might embrace some form of Medicaid expansion.

Then there’s Kansas state Rep. Susan Concannon, a moderate Republican who wants to expand Medicaid in her state. As she told the AP: “I think it gives us a chance.”

RELATED: New CMS guidance paves way for states to test Medicaid work requirements

Both Kansas and Utah are among the 18 states that have opted against expanding Medicaid eligibility—decisions made possible by the 2012 Supreme Court ruling. That choice comes at a price, as studies have found Medicaid expansion states experience lower uninsured rates, fewer hospital closures and lower uncompensated care costs borne by hospitals.  

The Trump administration’s position on Medicaid work requirements could indeed tip the scales toward expansion for some of those states, National Association of Medicaid Directors Director Matt Salo told the AP. Or it could at least ensure that current expansion states continue to support the program, he said.

The Obama administration generally opposed work requirements for Medicaid. But earlier this month, the Centers for Medicare & Medicaid Services approved a waiver from Kentucky that will make the state the first to impose work requirements on Medicaid beneficiaries. Some will also be required to pay income-based premiums.

And for those who fail to meet the new work and “community engagement” requirements, the state will give them a unique option to regain eligibility—passing a health or financial literacy course.

Kristi Putnam, a manager with Kentucky’s new state Medicaid program, told New York Times contributor Austin Frakt that the courses may include instruction on household budgeting, opening a checking account, weight management and chronic disease management.

Not everyone is convinced, however, that particular policy is a good idea.

“Requiring people to pass a health literacy course to get care—care for conditions that might prevent them from passing—is just expensive, punitive and cruel,” said Atul Gawande, M.D., of the Harvard T.H. Chan School of Public Health.