(January 12, 2018) Yesterday, the Centers for Medicare & Medicaid (CMS) issued guidance to states that would allow them to condition Medicaid eligibility on fulfilling work and “community engagement” requirements. This represents an unprecedented change to Medicaid eligibility that threatens healthcare for millions of low-income persons, including older adults who are not yet eligible for Medicare, people with disabilities and chronic health conditions, and family caregivers.

Not only have punitive work requirements been proven ineffective at lifting people out of poverty or improving health outcomes, they are also extremely burdensome for beneficiaries to navigate and for states to administer. Requiring people to verify that they are either working or exempt from the requirement will inevitably lead to Medicaid-eligible people falling through the cracks simply because the process is too complicated, onerous or doesn’t work correctly.

CMS intends to allow states broad leeway in determining who would be subject to work requirements and what activities would satisfy those requirements.  For example, while CMS recognizes that Medicaid beneficiaries may be caregiving for elderly family members, there are no required protections for caregivers. As a result, depending on how the state defines “work,” family caregivers, who are more likely to be women, risk losing their health coverage. Similarly, many people with chronic health conditions and disabilities that limit their ability to work could be excluded from coverage or face onerous verification processes to be exempted from a work requirement.

We strongly oppose this change in longstanding policy as defying the objectives of the Medicaid program and endangering the lives and well-being of those who rely on it. We urge CMS to reconsider this policy and call on states to maintain the purpose of Medicaid, protect the health of their residents, and not impose work requirements.