Rep. Moore Leads 72 Lawmakers in Letter of Opposition to Medicaid Work Requirements Guidance
Letter in response to guidance issued by the Trump administration allowing states to impose work requirements on Medicaid beneficiaries
In response to guidance issued by the Trump administration allowing states to impose work requirements on Medicaid beneficiaries, Congresswoman Gwen Moore (WI-04) led a letter with 72 of her congressional colleagues to the Centers for Medicare and Medicaid Services requesting they promptly rescind these reckless and dangerous changes.
The letter references several studies that demonstrate the adverse impact of imposing work requirements on low-income individuals. According to reports by the Center for Budget and Policy Priorities and the Kaiser Family Foundation, levying such harsh parameters not only fails to help recipients lift themselves out of poverty, but also degrades the economic well-being of vulnerable populations who lose access to the social safety net.
“Health care is a human right that this government should not restrict or make conditional,” wrote the lawmakers. “Denying coverage to those eligible for Medicaid will not encourage them to work, but would instead restrict their access to health care services and endanger their health. Please rescind this harmful and unprecedented guidance immediately.”
See the full text of the letter below:
January 25, 2018
The Honorable Seema Verma
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244
Dear Administrator Verma:
We write to express our strong disapproval of the January 11, 2018 guidance issued by the Centers for Medicare and Medicaid Services (CMS) that would allow states to impose work requirements on Medicaid beneficiaries. CMS’s guidance contradicts the clear intent of Congress in passing the Medicaid Act to provide health care for low-income people and is an unprecedented and likely illegal shift to Medicaid policy. We ask that you rescind this harmful guidance and deny all state applications to apply work requirements to Medicaid.
The Medicaid program was established by Congress to provide “medical assistance [to all eligible individuals] whose income and resources are insufficient to meet the costs of necessary medical services.” Congress was clear in requiring that through Medicaid, medical assistance be provided to all eligible individuals, regardless of employment status. This intent should be reflected in CMS’s execution of the program and its efforts to work with states to expand and improve access to health care services for vulnerable populations. CMS’s guidance does the opposite.
Numerous studies, including from the Center for Budget and Policy Priorities and the Kaiser Family Foundation (KFF), show that imposing work requirements on people who are already suffering through hardship is ineffective in reducing poverty, ejects people from the program, and can even worsen the economic status of families and individuals who lose access to the social safety net. The Temporary Assistance for Needy Families (TANF) program provides an example of the ineffective and harmful imposition of work requirements on beneficiaries. According to a 2015 study conducted by the University of Maryland, TANF recipients subjected to work requirements experienced only a modest and short-lived increase in employment. The study found that stable employment was the exception, not the norm, and many of the recipients subject to work requirements became financially worse off.
Imposing work requirements on Medicaid recipients would not only be ineffective, it is also unnecessary. Many Medicaid recipients already work multiple low-paying jobs that do not afford them the ability to pay for even their most basic needs. According to the KFF, nearly 60 percent of working-age adults on Medicaid are already employed, mainly for employers that don’t offer health insurance. Of those who are not working, most report reasons such as illness, caring for a family member, or going to school. Six percent express a desire to work but lack the ability to secure employment, and many say that enrolling in Medicaid has enabled them to improve their health enough to return to work. CMS has failed to provide any reliable evidence showing the efficacy of imposing work requirements on Medicaid beneficiaries to promote Medicaid’s objectives or reduce poverty. CMS has simply chosen to ignore research showing that restricting access to Medicaid would worsen outcomes for those reliant on the program.
The imposition of work requirements not authorized by Congress would only worsen the hardship of Medicaid recipients already struggling to make ends meet and would likely be illegal. Prior to the Trump administration, CMS had never approved conditioning Medicaid eligibility on meeting a work requirement, nor has Congress ever passed legislation imposing such a condition on eligibility. In fact, before January 12, 2018, CMS had consistently denied states’ requests to apply work requirements to Medicaid eligibility. In a November 2016 letter to the Commissioner of the New Hampshire Department of Health and Human Services, CMS rejected that state’s request to impose work requirements noting:
After reviewing New Hampshire’s amendment request to determine whether it meets these standards, CMS is unable to approve the following requests, which could undermine access, efficiency, and quality of care provided to Medicaid beneficiaries and do not support the objectives of the Medicaid program….
Health care is a human right that this government should not restrict or make conditional. Denying coverage to those eligible for Medicaid will not encourage them to work, but would instead restrict their access to health care services and endanger their health. Please rescind this harmful and unprecedented guidance immediately.
We look forward to your response.
Members of Congress