The week before last, the Centers for Medicare and Medicaid Services (CMS) issued a State Medicaid Director letter providing new guidance for Section 1115 waiver proposals that would impose work requirements (referred to as “community engagement”) in Medicaid as a condition of eligibility. This is a significant policy shift for Medicaid – but was not unexpected given a speech from CMS Director, Seema Verna, last fall. Kentucky’s waiver request for work requirements was approved, and nine other states have submitted waiver requests including some sort of work requirement for expansion or traditional Medicaid adults. However, most nonelderly Medicaid adults already are working or face significant barriers to work, leaving a very small share of adults to whom these policies are directed (see Figure 1 below). This week, the National Health Law Program (NHeLP), the Kentucky Equal Justice Center, and the Southern Poverty Law Center filed a lawsuit challenging the approved Medicaid waiver in Kentucky.

Fortunately, Washington State has no intention of imposing Medicaid requirements: “What we are doing is providing targeted supports that will help qualified Apple Health clients to maintain housing and jobs—and ultimately self-sufficiency,” Health Care Authority Director Sue Birch said.