The Trump administration favors work or “community engagement” requirements for Medicaid recipients. | Courtesy Pixabay

As Kentucky waits to see whether the main portion of its plan to overhaul Medicaid gets greenlighted, the federal government continues to back work requirements in other states.

Last week, Wisconsin became one of four states that now have approval from the U.S. Centers for Medicare and Medicaid Services to place such restrictions on Medicaid recipients.

In a recent blog post announcing the Wisconsin approval, CMS administrator Seema Verma acknowledged that work requirements are controversial but showed no sign of backing down from them. “We will not retreat from this position.”

Among other things, Wisconsin’s BadgerCare Reform waiver will require certain working-age adults to participate in at least 80 hours a month of qualifying activities, such as working, job training or volunteering.

“We want to remove barriers to work and make it easier to get a job, while making sure public assistance is available for those who truly need it,” Gov. Scott Walker said in a news release.

Kentucky wants to institute a similar requirement for “able-bodied” Medicaid recipients who do not have an exemption. But its Section 1115 waiver — also known as Kentucky HEALTH — has been stymied by a lawsuit that resulted in U.S. district judge James Boasberg kicking the waiver back to the federal government for further review.

The lawsuit was filed on behalf of more than a dozen Medicaid recipients who argued that the Trump administration’s initial approval of the waiver in January violated federal law and would jeopardize the health care coverage of tens of thousands of Kentuckians.

Seema Verma

In her blog post, Verma noted that Wisconsin joined Indiana, Arkansas and New Hampshire in adding a community engagement program to “help incentivize working-age adult beneficiaries to participate in activities like job training and employment.”

“I recognize that there are people who disagree with this approach. Some believe that our sole purpose is to finance public benefits, even if that means lost opportunity and a life tethered to government dependence,” she wrote. “Instead, what’s needed are local solutions crafted by policy makers who are closer to the people they serve and the unique challenges their communities face. We will not retreat from this position.”

Verma also noted that some leniency has been built into Wisconsin’s plan.

“Wisconsin beneficiaries will have 48 aggregate months – a total of four years – to come into compliance with the requirement before they will be subject to a six-month period of noneligibility, after which they will be free to re-enroll and start a new 48-month clock,” she stated. “This is a thoughtful and reasonable policy, and one that is rooted in compassion.”


Dustin Pugel, a policy analyst with the Kentucky Center for Economic Policy, has concerns about the federal government’s support for Medicaid work requirements. He doesn’t think such rules have been helpful to people in other public assistance programs like Temporary Aid to Needy Families (TANF) and the Supplemental Nutrition Assistance Program (SNAP).

“CMS continues to approve work requirements despite the fact these barriers have a 20-year track record of keeping people from needed assistance without improving employment or reducing poverty,” Pugel said via email. “In the case of Medicaid work requirements, this is especially concerning because for many, medical assistance is a prerequisite for being able to work and otherwise thrive.”

However, he believes the federal court may still come to play in the outcome.

“CMS is very likely to re-approve the changes, but it is all but certain that they will go back before Judge Boasberg soon thereafter,” Pugel said.

“At that point, CMS will have to show that they adequately considered the public record and show that their plan fulfills the statutory purpose of Medicaid – furnishing medical assistance. … It seems clear to me that Kentucky’s waiver fails his test. I expect other states’ waivers will face a similar level of scrutiny at some point in the future.”

Darla Carter

Darla Carter

Darla Carter is a hometown girl who recently joined the staff of Insider Louisville to mostly cover health. She previously served as a longtime health and fitness writer for The Courier-Journal, where she also worked for the Metro, Neighborhoods and Features departments. Prior to that, the award-winning journalist wrote for newspapers elsewhere in Kentucky and Tennessee, covering a range of topics, from education to courts. She's a graduate of Western Kentucky University, where she studied journalism and philosophy, and is the proud mom of two young children.