Biden administration to move Friday to rescind Medicaid work requirements

The actions anticipated Friday, outlined in bullet points in the draft, will come two weeks after President Biden signed an executive order instructing officials to remove barriers to Medicaid coverage. Work requirements enabled under President Donald Trump were the one policy mentioned in Biden’s directive.

In practice, the moves have little immediate effect because work requirements adopted in three states — Arkansas, Kentucky and New Hampshire — have been ruled illegal by two levels of federal courts, and other states have held back during the legal challenges to the policy. A case on such requirements is now before the Supreme Court.

Still, the swift rescinding of the Trump administration’s effort to remake the safety-net program represents a particularly sharp pendulum swing on the ideological divide over the proper roles of government and individuals living under economic strain.

Spokesmen for the Department of Health and Human Services did not respond Thursday night to a request for comment on the plan, first reported by Politico.

Medicaid, a collaboration between the federal government and states, was a pillar of the War on Poverty of the mid-1960s and is the nation’s largest source of public health insurance. For years, conservative state leaders had sporadically asked federal officials to allow them to compel some people on Medicaid to work for their benefits, but such requests always had been rebuffed.

However, in early 2018, Seema Verma, then-administrator of the Centers for Medicare and Medicaid Services, issued a letter to state Medicaid directors inviting them to apply for permission to create what she called “community engagement requirements,” in which certain people on Medicaid would need to work or participate in activities to prepare for employment. That letter is expected to be withdrawn Friday, according to the draft and the individuals.

Verma and other proponents have contended that such requirements promote economic self-reliance, eventually weaning poor people off government assistance. Undeterred by court rulings against the requirements, she advocated them until the Trump administration ended last month. “I support innovative efforts by governors that are trying to help people, trying to lift them out of poverty and find a path forward” she told the Aspen Institute in October.

Opponents of the policy, including most Democrats, counter that insurance that helps poor people to be healthy is a prerequisite to being able to work. Unlike the federal welfare system, which has required work since the mid-1990s, they argue, health coverage should be considered a right, not a privilege that is contingent on following other rules.

In its planned announcement, the Biden administration said the requirements were especially unwise during the coronavirus pandemic, which has sickened millions of Americans and forced many out of work. The agency overseeing Medicaid “has serious concerns that now is not the appropriate time to test policies that risk a substantial loss of health care coverage or benefits,” according to the draft plan.

According to the 15-page document, the Trump administration approved work programs in 13 states, and 10 others were still seeking approval. A few withdrew when GOP governors were replaced by Democrats. Arkansas was the only state that actually implemented its requirements, and 18,000 poor residents there were removed from Medicaid rolls over several months before the program was blocked by a judge on the U.S. District Court for the District of Columbia.

Accompanying the steps to reverse the Trump policy, HHS also plans to release an analysis Friday assessing how the Trump policy limited low-income Americans’ access to health coverage, according to the two individuals familiar with the plans.

The analysis was overseen by Ben Sommers, a longtime Harvard researcher who joined HHS last month as a deputy assistant secretary for strategy and planning and had previously written about the drawbacks of Medicaid work requirements, the officials said. “[W]e found no evidence that the policy succeeded in its stated goal of promoting work and instead found substantial evidence of harm to health care coverage and access,” Sommers and colleagues wrote in a September 2020 analysis in the journal Health Affairs.

Sommers did not respond Thursday night to a request for comment.