President Joe Biden's administration all but shut the door on Medicaid work rules after CMS Administrator Chiquita Brooks-LaSure notified health officials in Ohio, South Carolina and Utah Tuesday that the agency would no longer allow them to require Medicaid enrollees to work, volunteer or attend training to access health coverage.
CMS started unwinding President Donald Trump's policy in February, when it advised states that work requirements would disappear unless they could prove the policy doesn't cause coverage losses or excessive hardships. Federal officials were unpersuaded.
"Considering the physical, mental, social, and economic toll the public health emergency has taken on individuals, CMS believes it is especially important that the low-income Medicaid beneficiaries in South Carolina be able to access coverage and care, without the initial and continued eligibility obstacle of the community engagement requirement that may be unreasonably difficult or impossible for individuals to meet under the circumstances of COVID-19 and its likely aftermath," Brooks-LaSure wrote in a letter to health officials in South Carolina.
The other states received similar letters, which followed the work requirements recisions in other states earlier this year. Prior to Biden's CMS taking those actions, several courts had struck down work requirements, including Arkansas'. When Arkansas implemented the policy in 2018, about one-quarter of Medicaid enrollees subject to the rule—or about 18,000 people—lost coverage over the course of just seven months.
Georgia is the last state with Medicaid waivers allowing work requirements still on the books. The state is still negotiating with CMS over its partial Medicaid expansion, which includes a work requirement. But the issue could ultimately be settled in court as Georgia Gov. Brian Kemp and other state Republicans have taken a hardline stance against a full Medicaid expansion. Other states could follow suit, but they would likely face an uphill legal battle.
Federal officials also sent a letter to Tennessee officials on Tuesday, saying that CMS will reopen public comments on the state's controversial plan to overhaul how it finances its Medicaid program by converting it to a block grant. A group of Tennessee Medicaid recipients filed a lawsuit in April, arguing that the Trump administration didn't have the power to approve the plan and that the public didn't get enough time to weigh in. The Trump administration had encouraged other states to pursue similar plans for Medicaid expansion.
Democrats and other opponents of Medicaid work requirements argue they're nothing more than an excuse to cut the social safety net, pointing to evidence that such mandates lead to coverage losses and don't increase employment.
The Trump administration had insisted that requiring people to work to receive Medicaid coverage would encourage more people to get jobs, keeping them healthier. But most experts agree that people are more likely to work when they are healthy, not that working causes people to get healthier.