Congressional Republicans are currently looking to slow the growth of federal Medicaid spending, which has surged from $161 billion to $616 billion over the past two decades. Although only 17% of Americans support reducing Medicaid spending; 62% support requiring most adults to work in order to gain eligibility. But, while work requirements command broad appeal among legislators, they are unlikely to greatly reduce the program’s costs.
Work requirements are generally sought as a way to mitigate the program’s work disincentives. Medicaid’s expansion to able-bodied adults under the 2010 Affordable Care Act provides comprehensive healthcare benefits (worth an average of $7,711 in 2023), which individuals would lose if they earned more than $20,120 – about the level of someone working full time at the minimum wage in most states.
In 2017, when the House of Representatives sought to permit states to condition Medicaid benefits for “nondisabled, nonelderly, nonpregnant adults” on individuals’ “participation in work activities”; companion legislation was blocked in the Senate. But the first Trump administration approved 13 waivers for states to implement similar work requirements. These typically required Medicaid beneficiaries to dedicate 80 hours per month to work, volunteer activity, full-time education, or job training, while exempting those who were disabled, pregnant, medically frail, or personal caregivers. But such Medicaid work requirements were struck down by the courts for all states except Georgia (which used non-ACA expansion funding).
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Chris Pope is a senior fellow at the Manhattan Institute. Follow him on Twitter here.
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