Medicaid Work Requirements: Update on Waivers and State Legislation

May 10, 2018|3:51 p.m.| ASTHO Staff

In January 2018, CMS issued guidance indicating that it would enable states to include work requirements within their Medicaid programs through Section 1115 waivers. Four Medicaid expansion states have obtained approval to apply work requirements to their expansion populations and press reports have speculated CMS’ new direction may encourage non-expansion states to expand Medicaid, in exchange for granting work requirements. However, the majority of states pursuing work requirements are not pursuing Medicaid expansion in exchange for them, but rather are seeking waivers to apply work requirements to their standard Medicaid populations. Standard Medicaid populations are dominated typically by children, expectant mothers, senior citizens, and people with disabilities.  The Center for Budget and Public Policy Priorities and Georgetown’s Center for Children and Families have raised concerns about applying work requirements to any Medicaid population. To date, states pursuing work requirements are generally seeking to apply them only to very low-income parents or childless adults, with annual incomes ranging from $4,444-$16,460 for a family of two, depending on the state.

CMS has approved Section 1115 research and demonstration waivers that include work requirement in four Medicaid Expansion states: Kentucky , Indiana, Arkansas, and New Hampshire. Enrollees in Arkansas who are not compliant with the work requirement for any three months in a year will be locked out of coverage until the next plan year. In Kentucky, New Hampshire and Indiana, enrollees who fail to comply with work requirements can regain coverage after documenting their return to compliance. After CMS issued its approval of Kentucky’s waiver in January, Medicaid enrollees in the state filed a lawsuit in federal court, challenging CMS’s authority to issue the work requirement policy and approve Kentucky’s waiver.

Six states have submitted waiver requests that include work requirements to CMS: Arizona, Kansas, Maine, Mississippi, Utah, and Wisconsin. Five of those states (Kansas, Maine, Mississippi, Utah, and Wisconsin) are non-expansion states and are seeking to apply work requirements to low-income parents and adults already covered by the Medicaid program.

In addition to the waivers, state legislatures introduced legislation directing their Medicaid programs to implement work requirements. To date, 14 states have pending legislation on Medicaid work requirements. Tennessee and Oklahoma recently approved legislation in both chambers. In Tennessee, the Governor is expected to receive the legislation for enactment, and in Oklahoma, the legislation awaits another House vote.

Several other states have indicated they are exploring requiring their Medicaid program to pursue approval for work requirements from CMS, including Alabama, Ohio, South Carolina, and West Virginia.

States vary on whether legislative action is required for a state Medicaid agency to submit an 1115 waiver request, however, state lawmakers generally play a critical role in influencing state priorities.

State Legislation: Medicaid Work Requirements

State

Bill

Date

Status

Alaska

HB 356

Feb. 16

Introduced

SB 193

Feb. 19

Introduced

Colorado

SB 214

Mar. 29 

Failed

Connecticut

SB 270

Feb. 28

Introduced

Illinois

SB 3306

Feb. 16

Introduced

Louisiana

HB 46

Jan. 31

Introduced

HB 3

Feb. 15

Introduced

SB 77

Feb. 21

Introduced

SB 5

Feb. 16

Introduced

Maryland

HB 1477

March 1

Failed

SB 0866

March 9

Failed

Michigan

HB 5590

Feb. 15

Introduced

HB 5701

March 8

Introduced

HB 5716

March 13

Introduced

SB 897

April 19

Passed Senate

Minnesota

HF 3722

March 12

Introduced

SF 3219

March 12

Introduced

SF 3611

March 19

Introduced

New York

SB 7959

March 13

Introduced

North Carolina*

HB 662

April 4, 2017

Introduced

Oklahoma

HB 2932

April 18

Passed House and Senate

Pennsylvania

HB 2024

Jan. 22

Introduced

HB 2138

April 18

Passed House

Tennessee

HB 1551

April 18

Passed House and Senate

Virginia

HB 338

Feb. 12

Passed House

HB 695

Jan. 30

Introduced

SB 572

Jan. 25

Introduced

Vermont

H 823

Feb. 1

Introduced

Washington state

SB 6540

Jan. 23

Introduced

*On Nov. 20, 2017, North Carolina submitted a waiver application to CMS that included Medicaid work requirements. However, even if CMS approves the waiver application, work requirements would only occur if the state enacted proposed legislation (HB 662), that would also expand its Medicaid program.