As budget fights continue in the nation's capital over funding of public insurance programs like Medicare and the ACA, work requirements for Medicaid have once again resurfaced in potential proposals.
Republicans have not officially said whether they will act to reduce spending on federal healthcare programs, but they have signaled some openness to making changes. During a speech Feb. 28 in Virginia, President Joe Biden discussed a proposal drafted by Russell Vought, who served as former President Donald Trump's budget director. The proposal would fully repeal the ACA's Medicaid expansion and require all physically-able individuals of working age to be actively employed or be looking for employment to receive Medicaid benefits.
"By providing incentives for individuals to engage with their communities, this proposal will improve the physical and mental health and well-being of Medicaid beneficiaries," the authors wrote.
Rep. Jodey Arrington, chairman of the House Budget Committee, told Reuters that lawmakers are reviewing policies "consistent" with what Mr. Vought is proposing.
"We're just beginning to have those conversations, but certainly members have talked to me about looking at work requirements for some of the able-bodied in Medicaid," House Energy and Commerce Chair Cathy McMorris Rodgers told Axios March 7.
Before President Trump, no state had received federal permission to implement work requirements for low-income individuals, according to the Kaiser Family Foundation. During his administration, 13 states were approved to move forward with the policy, while nine others had pending requests with CMS to do the same.
Under the Biden administration, CMS has withdrawn those waivers for state Medicaid work requirements, and many were also struck down by federal courts. The White House has argued that work requirements lead to reduced coverage and do not align with the overall goals of the Medicaid program.
Some states however have renewed their efforts in 2023 to reinstate work requirements under Medicaid.
Georgia is set to begin a Medicaid work requirement program July 1. The program will require enrollees to complete 80 hours of work, job training, education or community service per month to receive coverage.
In Arkansas, Gov. Sarah Huckabee Sanders has asked the federal government for a waiver to create work requirements in her state. The proposal would require people to work, go to school or volunteer in order to be eligible for benefits.
Arkansas became the first state to enact Medicaid work requirements in 2018, which led to about 18,000 adults losing coverage. In 2019, a federal judge ruled against the requirement — along with a similar requirement in Kentucky — which led to a restoration of benefits for most Arkansas residents who had lost coverage.
Ms. Sanders said her new proposal differs from the 2018 requirement because those who do not participate in the program would revert to fee-for-service coverage.
South Dakota voters passed a Medicaid expansion measure in November. State lawmakers have proposed a ballot issue that would ask voters whether to add work requirements to the expansion. The Senate Health and Human Services Committee voted down the proposed legislation on Feb. 24, however, according to South Dakota Public Radio.