Medicaid Work Requirements

February 26, 2021

ACS CAN and 14 other health groups filed a “friend of the court” or amicus brief at the Supreme Court of the United States (SCOTUS) opposing state imposition of work or community engagement requirements for Medicaid beneficiaries.  Read our press statement.

By way of background, section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental projects likely to assist in promoting the objectives of the Medicaid statute.  The Obama administration consistently rejected states’ applications for 1115 waivers that would tie Medicaid benefits to work and community engagement requirements.  However, in January of 2018, the Trump administration reversed course, with the Centers for Medicare and Medicaid Services (CMS) issuing a letter encouraging states to move forward with waivers that included work requirements.  A number of states submitted such applications, many being granted.  Litigation against HHS ensued, with the result of four states’ waivers being set aside by the courts as failing to meet the Medicaid statute’s overarching purpose of providing access to insurance coverage.  

In Arkansas, the only state to implement the requirements, 18,000 enrollees lost coverage in less a year, mostly due to the administrative burden associated with the required reporting.  A federal district court put the requirements on hold.  The Circuit Court of Appeals for the District of Columbia unanimously struck down Kentucky’s work requirements on appeal, though the state later rescinded those requirements.  ACS CAN had also filed an amicus brief in that case.

HHS appealed two of the cases, pertaining to Arkansas and New Hampshire, to SCOTUS.   In December, SCOTUS consolidated the cases and agreed to decide the issue of whether such requirements are permissible in the case now titled Cochran v. Gresham.

ACS CAN has consistently opposed work and community engagement requirements because they will result in patients finding themselves without Medicaid coverage, and reporting requirements could create barriers to lifesaving care.  More than 60% of nonelderly adults with Medicaid already work either full or part time. Imposing work requirements could unfairly penalize those unable to work; cancer patients, survivors, and those who will be diagnosed with the disease - as well as those with other complex chronic conditions - could find themselves without Medicaid coverage.  Over two million people with a history of cancer rely on Medicaid for their health insurance.
Actions by the new Biden administration and/or states may at some point moot the case.  Oral arguments are currently scheduled at SCOTUS for March 29, 2021.