CMS Releases Guidance on Work Requirement Waivers

The Trump Administration this week continued encouraging states to weave work requirements into their Medicaid programs by releasing guidance on implementing, monitoring, and evaluating such changes. The new tools from the Centers for Medicare and Medicaid Services (CMS) are meant to provide guidance on creating effective demonstrations under Medicaid waiver authorities, particularly for waivers permitting states to implement work requirements and other experimental eligibility and coverage policies. As the Administration moves toward approving such waivers in more states, the National Council remains vehemently opposed to these harmful policies as they restrict access to needed mental health and addiction services.


States are encouraged to tailor their Medicaid programs to address their residents’ unique challenges by creating demonstration programs via a mechanism called 1115 waivers, which must first be approved by CMS before going into effect. Over the past two years, many states have submitted 1115 waivers that would allow them to require certain Medicaid recipients to report a number of hours per month of work or “community engagement” activities, such as volunteering or pursuing education, or risk losing their health coverage. The Trump Administration has approved work requirements for nine states so far, while seven more are awaiting approval, and CMS continues to signal support for these changes via official announcements like the 1115 waiver guidance issued this week. In Arkansas, where beneficiaries have been required to report work hours since last summer, over 18,000 residents have lost their Medicaid coverage for failing to report 80 hours per month.


While CMS Administrator Seema Verma insists that the intent of Medicaid work requirements is to “help families break cycles of generational poverty and improve their health and financial independence,” data continues to mount showing the harmful impact of these policies. A new report from the Center for Budget and Policy Priorities finds that Medicaid coverage losses in Arkansas attributable to the work requirements have exceeded preliminary projections, and that, based on preliminary data, the requirements do not seem to have the desired effect of increasing employment among those subject to the mandate.

Additionally, legal battles over CMS’ approval of states’ work requirement waivers continue to grow. For example, Kentucky’s request remains in its second round of legal review in a District Court while a new lawsuit was filed this week against the Trump Administration’s approval of similar Medicaid work requirements in New Hampshire. The National Council remains strongly opposed to any provisions, such as these harmful work requirements, that create barriers to health coverage for individuals living with mental illness or substance use disorders.

Guest Author

Shelley Starkey