Rosenbaum Blogs in Health Affairs on Medicaid 1115 and Work Requirements

In a timely blog in Health Affairs, George Washington University Milken Institute School of Public Health Professor Sara Rosenbaum responds to the Trump administration’s letter of January 11 inviting states to propose demonstrations to test the effects of threatening to withdraw or reduce Medicaid from people who fail to meet work requirements. 

In the Health Affairs blog, “Unpacking the Trump Administration’s Section 1115 Medicaid Work Demonstration Solicitation," Rosenbaum, the school’s Harold and Jane Hirsh Professor of Health Law and Policy, presents her analysis of the solicitation.  The letter announces “a new policy designed to assist states in their efforts to improve Medicaid enrollee health and well-being through incentivizing work and community engagement among non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability.” 

As the blog points out, eleven states currently have applications in the pipeline, including the state of Kentucky’s demonstration, which was approved on January 12.  Two more states also appear to be considering applying for demonstrations through section 1115 of the Social Security Act, which gives the U.S. Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and Children’s Health Insurance Program programs. 

In the blog, Rosenbaum contends that the premise underlying the solicitation, that working-age adults need a prod toward gainful employment, is erroneous.  She also explains how civil rights laws and due process protections may come into play. 

Rosenbaum explains why she believes that withdrawing health care from people who don’t satisfy the new proposals’ requirements creates a public health threat, especially in the poorest communities with widespread reliance on the program.