White House Makes Case for Work Requirements in Safety-Net Programs

Allison Inserro

The White House released a report saying the time is right to impose work requirements on 3 noncash welfare programs—food stamps, housing assistance, and Medicaid. Adding work requirements to these programs would reduce dependency upon them by nondisabled, working-age beneficiaries receiving such assistance, as poverty as fallen since the programs were created, the report from the Council of Economic Advisors (CEA) said.

With tight labor markets, “now is the ideal time to expand carefully designed work requirements to noncash welfare programs," according to the report.

The report follows President Donald Trump’s executive order from April 2018 that instructed agencies to reform welfare programs by strengthening and expanding work requirements.

Expanding Work Requirements in Non-Cash Welfare Programs said nondisabled, working-age adults make up the majority of recipients on Medicaid (61%), the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps; 67%), and rental housing assistance programs (59%) as of December 2013, based on data from the Survey of Income and Program Participation. In addition, most of these adults—60% of those on Medicaid and SNAP and 52% of those receiving housing assistance—do not regularly report work hours.  

Those figures are at odds with numbers put forth by organizations like the Henry J. Kaiser Family Foundation, which has said that most Medicaid beneficiaries who can work already do, but they are grappling with complying with reporting requirements.

KFF has said the more than 6 in 10 Medicaid enrollees who are working typically work in low-wage jobs with limited benefits or health coverage and are unlikely to achieve self-suffiency at that level. In addition, those in nonexpansion states could find a job that puts them out of reach of Medicaid, without access to health coverage through the individual Affordable Care Act marketplace.

Access to food and the quality of one’s housing—the kind of help provided by SNAP or housing assistance—are some of the factors in social determinants of health, which are those things that take place outside of a medical setting contributing to a person’s health.

Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy, founding chair of the Department of Health Policy at the Milken Institute School of Public Health, George Washington University, has been critical of Medicaid work requirements and indicated the content of the CEA report was similar to the reasoning that had been struck down by a federal judge ruling on Kentucky’s Medicaid waiver. The judge in Stewart v Azar said HHS had failed to consider that people would lose their health coverage as a result of the work requirements.

So far, 4 states have CMS-approved waivers to implement Medicaid work requirements, and 7 states have waiver requests pending with CMS.

“Like the HHS analysis struck down in Stewart, the report utterly fails to even the acknowledgement of a large scale withdrawal of coverage or other subsistence benefits from people unable to meet their conditions, nor the spillover effects of such major reductions on families and entire communities,” said Rosenbaum in an email to The American Journal of Managed Care®.

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