HHS’s Invitation to Impose Punitive Work Requirements Lacks Support

HHS’s Invitation to Impose Punitive Work Requirements Lacks Support

National Health Law Program Condemns Reversal of Longstanding Policy

Washington – In an unprecedented move, HHS today issued a letter announcing its intention to approve state requests to impose work requirements on Medicaid enrollees. The National Health Law Program (NHeLP) responded swiftly, submitting a letter to the Centers for Medicare & Medicaid Services (CMS), explaining why the radical shift in Medicaid policy is procedurally and substantively flawed.

NHeLP Legal Director Jane Perkins said CMS is seeking to reverse longstanding policy in an unorthodox manner.

“The Trump administration is on wobbly legal ground in trying to limit Medicaid enrollment by imposing onerous work requirements,” Perkins said. “As our letter explains, the administration is making an about face in its efforts to overturn established HHS policy against work requirements without public comment.”

Perkins also notes, “CMS’s novel proposition that work requirements are consistent with the objectives of the Medicaid Act comes only after the state and federal comment periods have closed on at least seven state proposals which contain work requirements. Yet, CMS will most certainly base its approval of work requests on this letter. By waiting and issuing this substantive letter in this way, CMS has effectively undermined stakeholders’ ability to comment meaningfully during these prior comment periods.”

According to the NHeLP letter, “Equally troubling, CMS’s rationale in the letter entirely ignores the wealth of literature regarding the negative health consequences of work requirements, which was repeatedly cited by NHeLP and others in those state-specific comments. It appears CMS has decided on a policy position first and then cherry-picked a small number of studies in an effort to justify this drastic shift in agency policy.”

The letter incorporates a Statement of Review from the Center on Budget and Policy Priorities’ LaDonna Pavetti concluding that the few studies CMS cites to support work requirements do not backup CMS’s conclusion that any and all work produces positive health outcomes.

“None of the studies CMS cites indicate that requiring work as condition of Medicaid eligibility is likely to promote positive health outcomes,” NHeLP Policy Analyst David Macheldt said. “In fact, as our letter notes, the evidence points to the exact opposite effect – yanking people off of Medicaid will likely have negative consequences, harming their health and well-being.”

NHeLP’s Health Policy Director Leonardo Cuello said CMS’s letter also failed to acknowledge evidence that quality of work matters in determining health outcomes. “So, it is false to state that any work will produce positive health outcomes,” Cuello said. “Indeed, the research cited by CMS specifically notes that the quality of work has a major impact on health outcomes.”

Pavetti’s Statement notes, “But the evidence cited by CMS once again undercuts” its conclusion that work means positive health outcomes. It continues, “In fact … individuals who lost social security benefits suffered worse health outcomes partly because they often work in poor-quality, low-wage jobs and have ongoing issues with job security. Decent job options can be scarce for this population and enforcing a work requirement that funnels beneficiaries toward predominantly temporary, dead-end jobs could actually worsen their health outcomes.”

Read NHeLP’s entire letter about CMS’s “State Medicaid Director Letter,” and see our Waivers page for more information on efforts by the Trump administration and states to weaken Medicaid law.

Please contact the NHeLP Communications Department at leaming@healthlaw.org or 202-552-5176 to speak with Cuello, Perkins or Machledt for additional comments.

NHeLP, founded in 1969, advocates for the rights of low-income and underserved people to access quality health care.

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