On Jan. 11, the Trump administration laid out a clear path to move millions of able-bodied adults from welfare to work. In a letter to state Medicaid directors, the Centers for Medicare and Medicaid Services set forth new guidance for states pursuing Medicaid work requirements.
Under the guidance, states can receive waivers to require able-bodied adults to work, train, or volunteer as a condition of Medicaid eligibility. This will finally bring Medicaid into alignment with other major welfare programs, which have successfully used similar rules for decades.
Work requirements have proven to be a highly effective way to move adults out of dependency. When states implemented work requirements in other welfare programs, they saw able-bodied adults leave welfare in record numbers and find work in more than 600 different industries. Those leaving welfare saw their incomes more than double on average.
But until Thursday, Medicaid had been disconnected from these commonsense rules, and it shows. Although work is the best way out of dependency, few able-bodied adults on Medicaid work full-time jobs, and most don’t work at all. Thursday’s guidance from the Trump administration can change that, by allowing states to build on their successes and align work requirements across all major welfare programs.
This new guidance could not have come at a better time. States are already grappling with skyrocketing enrollment and Medicaid costs, largely driven by able-bodied adults. Nationwide, nearly 28 million able-bodied adults are now dependent on the program, up from fewer than 7 million in 2000. This enrollment explosion is fueling a massive spending surge, with spending on able-bodied adults having increased by a jaw-dropping 700 percent over that same time.
The implications of the status quo are clear: Fewer dollars are available for truly vulnerable individuals who depend on the Medicaid program to survive. Fewer dollars are available for important budget priorities like education, public safety, and infrastructure. And prior to Thursday’s guidance, there was no end in sight.
But now, reform is imminent. More than a dozen states have waivers pending, out for public comment, or being prepared to implement these commonsense requirements. Many of these waivers already conform with the new guidance, so there should be little delay in gaining final approval from the Trump administration.
Thursday’s guidance is another critical step forward for welfare reform. And it makes it clear that President Trump remains fully committed to moving people from welfare to work.
Jonathan Ingram is vice president of research at the Foundation for Government Accountability.
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