House committee pushes through Medicaid work requirements

The House Energy and Commerce Committee has approved numerous provisions that would change Medicaid, including enacting nationwide work requirements.

The changes, approved within the committee on a 30-24 party-line vote, are likely to create some $715 billion in cost savings.

Inside the legislation are numerous changes intended to trim Medicaid, ranging from immigrant coverage to financing Medicaid expansion.

However, perhaps most notable are the addition of nationwide work requirements. Currently, Medicaid prohibits work requirements. However, under the first Trump administration, 13 states were approved for enacting work requirements using Section 1115 demonstration waivers.

The House bill language would federalize those work requirements. All states would have to require enrollees ages 19-64 to work or participate in community engagement activities for at least 80 hours each month. Certain adults would be exempt from the requirements, including individuals with certain disabilities and caregiving responsibilities.

The legislation would bar any states from waiving the provisions, including by Section 1115 demonstration waiver.

Experts estimate that between 4.6 and 5.2 million people could lose Medicaid coverage as a result of the legislation, should it make it through Congress. The vast majority of Medicaid enrollees already fulfill the outlined work or civic engagement requirements: 64% of adults on Medicaid already work full or part time, while another 12% care for dependents, another 10% are disabled or in poor health and 7% are attending school.

Instead, potentially complex paperwork or unclear reporting guidelines could cost people their coverage, experts predict.

That could have downstream effects on the economy, as fewer people access healthcare and hospitals and health systems see their margins strained further. Lower health sector employment, plus hits to Medicaid funding and tax revenue, could negatively impact GDP and the job market, per Commonwealth Fund reporting.

The draft language still awaits full discussion on the House floor where more changes may be made.

Sara Heath has covered news related to patient engagement and health equity since 2015.