Recently, policymakers have been discussing whether work requirements should have a place in the Medicaid program. In the last three years, some states have proposed mandatory or voluntary work programs as part of their Section 1115 Medicaid expansion waiver applications. To date, the Centers for Medicare and Medicaid Services (CMS) has not approved any state's request to require that Medicaid beneficiaries work as a condition of eligibility, on the basis that such a provision would not further the program's purposes of promoting health coverage and access. Some states have created voluntary job training and referral programs for Medicaid adults, but CMS has noted that these are state-run programs separate from the approved expansion waivers. On March 14, 2017, CMS signaled a change in this policy in a letter to state governors indicating that it will use Section 1115 authority to approve provisions related to "training, employment, and independence." Additionally, on March 20, 2017, the House released a manager's amendment proposing policy changes to the American Health Care Act (AHCA), including a state option to condition Medicaid eligibility for nondisabled, nonelderly, nonpregnant adults upon satisfaction of a work requirement (see Table 1). In general, work is an important societal goal, and Medicaid can play a key role in ensuring that people who are able to work have the necessary supports, such as health coverage, to do so. However, conditioning eligibility for health coverage on satisfying a work requirement, and terminating health coverage for those who are unable to comply, could penalize the people who most need these supports. Such policies, whether administratively through waivers or through legislation, would be a fundamental change to the Medicaid program. This issue brief reviews the current status of states' Section 1115 waiver requests relating to Medicaid work requirements (see Table 2) and identifies key policy questions to consider in terms of the impact on beneficiaries, states, and other stakeholders.
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