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RESOURCE: Georgetown University Highlights Concerns of Medicaid Work Requirements

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RESOURCE: Georgetown University Highlights Concerns of Medicaid Work Requirements

February 4, 2019

ANCOR is sharing this report by Georgetown University Law Center because we have been monitoring general discussions surrounding Medicaid work requirements. That is because we are concerned Medicaid work requirements might affect people with disabilities and the Direct Support Professional (DSP) workforce, which is essential to the well-being of people with disabilities. Last year, we shared those concerns with the Centers for Medicare and Medicaid Services (CMS).

As written by the Center on Poverty and Inequality at Georgetown University Law Center:

“The connection [of work requirement reporting] to other proposals, often proposed with similar rationales and based on similar misunderstandings of programs and participants, suggests a need to detail the sizeable body of evidence of the effectiveness of Medicaid, SNAP, and housing assistance in supporting people with low incomes as they overcome challenges they face.


 In this report, we examine how the newly-proposed ‘work requirements’ in Medicaid, SNAP, and housing assistance are ill-informed, ineffective, inefficient, and inequitable, and how alternative policies would produce outcomes that reduce poverty and increase opportunity:

• Ill-Informed. Weakening foundational programs by taking benefits away from people who do not meet harsh work requirements ignores the realities of today’s low-wage labor market and the systemic barriers—such as caregiving responsibilities and discrimination—standing between people and quality, stable, and secure employment. At the same time, the majority of working age program participants without a work-limiting disability generally work.

• Ineffective. Though they should be strengthened, the affected economic security programs are designed to and already do support and enable work. Mandatory work requirements, on the other hand, are generally ineffective at achieving their goal of reducing poverty through greater employment and earnings. In fact, they likely will result in the deepening or increasing of poverty and compound existing challenges with an already overburdened, underfunded workforce system. Because states fail to communicate effectively about how to fulfill the burdensome documentation and reporting processes, many working participants are in danger of losing needed benefits and services.

• Inefficient. Work requirements are costly to administer and time-intensive for all involved. Program administrators will spend more time implementing these requirements than focusing on supporting the health, housing, and income support needs of participants. Furthermore, the burden of proof for exemptions and compliance falls on already-struggling people. In particular, people with disabilities who lack Social Security Disability Insurance (SSDI) and SSI benefits and people with substantial economic disadvantages are likely to unfairly face work requirements and struggle to document compliance with them. These sanctions also undermine the effectiveness of economic security programs in countering recessions.

• Inequitable. Taking away access to foundational programs from people who do not meet work requirements puts populations that are already facing systemic discrimination or other barriers, including children, people with disabilities, caregivers, older workers, and workers of color, further at risk. Work requirements will deepen existing inequities, including in negative physical and behavioral health outcomes, poverty and deep poverty, and for community-wide outcomes.”