The road to expand the use of work requirements in the U.S. welfare system has been anything but smooth for the Trump administration, with the most recent blow coming out of Congress as lawmakers dropped a proposal to enact stricter work requirements in the nation's largest federal food assistance program.
But Congress, where conservative House lawmakers had attempted to include the proposal in the farm bill, is not the only tool that the administration is relying on to enhance this policy initiative. Agriculture Secretary Sonny Perdue is already eyeing regulations that aim to get more people in the Supplemental Nutrition Assistance Program working. This would likely add to the flurry of activity expected around work requirements next year when potentially four states enact them in their Medicaid programs.
Having the proposal for new work requirements scrapped during congressional negotiations is one of a handful of speed bumps that the Trump administration has encountered in its goal to encourage employment among beneficiaries of safety-net programs, particularly in Medicaid and SNAP. The administration has attracted lawsuits, pushback from Congress, and criticism when thousands were disenrolled from Medicaid.
Experts also remain concerned that these policies will not lead more people into the workforce, but instead penalize beneficiaries who are already working. An October report from The Hamilton Project at the Brookings Institution found that proposed work requirements for Medicaid and SNAP would penalize more people who are already working than encourage more people into the workforce.
Hamilton Project Director Jay Shambaugh, who coauthored the report, said the biggest issue with these policies is the instability of the labor market for low-wage workers where hours can vary, thus putting them at risk for losing benefits.
“There are a lot of people in the United States who are in the labor force who aren’t getting 80 hours a month every month,” Shambaugh said. “If the goal of the work requirements is to push people into the labor force, these people are in the labor force most of the time. They’re just not always getting over this barrier that is being set to say, ‘Are you working?’”
The stricter work requirements that conservatives were pushing in the farm bill for SNAP would have required more able-bodied adults to meet hourly job training or employment requirements, but Perdue noted last week that the proposal was dropped. The Congressional Budget Office estimated these requirements would have lowered SNAP enrollment by 1.2 million in an average month.
With federal-level action stalled, much of the push around work requirements will be focused at the state level. Perdue wants to limit state use of a waiver that protects able-bodied adults who fail to fulfill the current SNAP work requirements from facing limitations on their benefits. Without the waiver, these recipients could only receive three months of SNAP benefits in three years. Regulations addressing this issue will be announced after the farm bill passes, he said.
“Through regulation, we’ll be able to I think please those conservatives who expected more work requirements in the farm bill as I did, as President Trump did,” said Perdue to a scrum of reporters after giving remarks Monday to the Illinois Farm Bureau, which made a recording of his remarks available.
The Agriculture Department has considered placing restrictions around these waivers and solicited feedback this year on how the department should do this. The department asked how it could define “lack of sufficient jobs,” whether states’ ability to define the geographic area they are applying the waiver should be limited, and if there should be changes to the data that states have to provide to support their waiver request.
States have already taken the lead in expanding the use of work requirements in the Medicaid program. Five have received clearance from the federal government so far to require beneficiaries to meet employment and community engagement requirements, with Arkansas being the only one so far to implement them.
As a result, more than 12,000 beneficiaries in Arkansas have lost coverage because they did not fulfill the work and reporting requirements.
The Medicaid and CHIP Payment and Access Commission called for a halt in the disenrollments to make program adjustments. “The low level of reporting is a strong warning signal that the current process may not be structured in a way that provides individuals an opportunity to succeed, with high stakes for beneficiaries who fail,” the commission wrote to Health and Human Services Secretary Alex Azar in November.
A lawsuit brought against the Health and Human Services Department over Arkansas’s Medicaid waiver argued that the state is only relying on an online portal for submitting work hours, placing a significant burden upon beneficiaries.
Kentucky would have also implemented its work requirements for the Medicaid program this year, but they were blocked by a D.C. federal district court at the end of June. On Nov. 20, the Centers for Medicare and Medicaid Services reapproved the waiver with some technical changes. But the key elements—including requiring adults in the Medicaid expansion population to work 80 hours per month—remain the same, according to a Kaiser Family Foundation analysis.
Next year will likely bring a plethora of activity with requirements in New Hampshire, Wisconsin, Kentucky, and Indiana expected to go into effect. Work requirements may also be part of the conversation in Utah, Idaho, and Nebraska, which just expanded Medicaid via ballot initiative.
“Where expansion has now been approved by the voters, the legislature has to authorize the funding,” said Judith Solomon, senior fellow at the Center on Budget and Policy Priorities. “I think there is an expectation that at least in one or more of those states they’re going to try to attach a work requirement.”
Solomon argued that work requirements in Medicaid are not the path forward to promote employment among beneficiaries. “These have no place in Medicaid, even though we agree with supportive programs that would help people work,” she said. “This is not that. This is taking health care away from people and that really goes against the whole premise of the objectives of Medicaid.”
CMS Administrator Seema Verma has continued to defend the policy of work requirements, telling reporters the administration is helping Arkansas review what is happening with its program.
“[States] wanted to create programs that were helping people to rise out of poverty, not just merely handing out a Medicaid card, but to really help that person,” said Verma in a Nov. 27 press briefing.
“We’re also living in a time of a booming economy where we have the lowest unemployment rate that we’ve had in many years,” she said. “There’s lots of jobs available and there are employers that need workers, and so I think that’s sort of the reasoning and the rationale behind moving forward on community engagement. We continue to support that.”