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Medicaid Work Requirements: A Bad Solution in Search of a Problem


CONTACT: Joy Burwell, 202.748.8789,

Medicaid Work Requirements: A Bad Solution in Search of a Problem

WASHINGTON, D.C. (Jan. 16, 2018) —The National Council for Behavioral Health opposes the restrictions to Medicaid that the Centers for Medicare & Medicaid Services (CMS) announced last week. These restrictions make it harder for people with substance use disorders or mental illness to receive the care they need. In addition, the restrictions are expensive and complicated for states to administer, are burdensome for recipients to understand and comply with and almost always result in people losing access to the care they need – all because of needless red tape.

Medicaid’s core mission is to provide comprehensive health coverage to low-income people so they can get needed health services. Section 1115 of the Social Security Act allows states to deviate from certain federal Medicaid requirements, but only when necessary to implement demonstration projects that promote Medicaid’s objectives. These restrictions take us far away from the core mission.

It’s important to note that most Medicaid beneficiaries who can work are already workingnearly eight in 10 non-disabled adults with Medicaid coverage live in working families, and most are working themselves. The majority of those who are not working have health conditions that prevent them from working, are caring for children or other family members who are ill or have a disability or are in school.

In addition, a substantial number of individuals with substance use disorders or mental illness also have a criminal history that is directly related to their untreated illness. The CMS guidance completely fails to recognize the discrimination and related legal and policy barriers to employment confronting these individuals. Imposing work requirements compound the obstacles they already face when trying to secure employment, while denying needed health care.

Studies of adults who gained coverage in Ohio and Michigan under the Affordable Care Act’s Medicaid expansion, found that gaining health coverage helped a majority look for work or remain employed. Losing coverage — and, with it, access to treatment of substance use disorders such as opioid addiction and mental illness — will have the reverse result of impeding future employment.

Work requirements are a political response to the stereotype of Medicaid recipients as lazy, living high on the hog rather than the reality of the sick, the disabled, the elderly and struggling working parents.


The National Council for Behavioral Health is the unifying voice of America’s health care organizations that deliver mental health and addictions treatment and services. Together with our 2,900 member organizations serving over 10 million adults, children and families living with mental illnesses and addictions, the National Council is committed to all Americans having access to comprehensive, high-quality care that affords every opportunity for recovery. The National Council introduced Mental Health First Aid USA and more than 1 million Americans have been trained. For more information, please visit

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