Health Department secretary open to national Medicaid work requirements

"We would work with Congress."

UNITED STATES - JANUARY 09: Alex Azar, nominee to be Department of Health and Human Services secretary, testifies during his Senate Finance Committee confirmation hearing in Dirksen Building on January 9, 2018. (Photo By Tom Williams/CQ Roll Call)
UNITED STATES - JANUARY 09: Alex Azar, nominee to be Department of Health and Human Services secretary, testifies during his Senate Finance Committee confirmation hearing in Dirksen Building on January 9, 2018. (Photo By Tom Williams/CQ Roll Call)

Health and Human Services Secretary Alex Azar told a Senate panel Thursday that he’s willing to work with Congress on legislation that would require people to work a designated amount of hours or lose Medicaid.

States that want to implement Medicaid work requirements have so far sought federal permission to do so, by waiver, but now, Sen. John Neely Kennedy (R-LA) is aiming to go further by proposing that the federal government impose work requirements across the board in every state, with Azar signalling his willingness to cooperate.

To date, the Centers for Medicare and Medicaid Services (CMS) has approved four state waivers that mandate Medicaid beneficiaries — many of whom are ill, poor, or have disabilities — obtain work or lose coverage. New Hampshire is the latest state to get federal approval, requiring some enrollees to work 100 hours per month or else get booted off coverage.

Azar’s comment came during an exchange with Kennedy, who’s unsatisfied with his state’s Medicaid work requirement legislation because it doesn’t require people to work per se, but connects enrollees with job training and education.


“Let’s put together an aggressive program that’s not optional for the states. My governor doesn’t want to do it. I believe in more freedom. My governor believes in more free stuff,” said Kennedy. “But put together a program not to throw people out in the cold, but just to say, ‘look, let us help you get a job. You can keep your benefits, but let us help you get a job.'”

Here’s part of the exchange:

Kennedy: I appreciate that CMS is willing to grant waivers, but why don’t we take the next step. Why don’t you take the lead on that? 

Azar: Well, I believe the president has led boldly here with the welfare reform executive order, with what we’re doing in Medicaid…

Kennedy: How about we pass a bill?

Azar: Well, we would work with Congress. SNAP — the SNAP program, the president has wanted work requirements in there.

Kennedy: — But they’re optional. It doesn’t need to be — sorry for interrupting, I’m not trying to be rude, I’m really not ..We don’t need to make it optional and we need you to take the lead and the president. I mean, the president is kind of busy right now, he’s working on a lot of stuff. I’d like you to take the lead and CMS to take the lead and say this is a win/win and we’re not throwing people out in the cold. We will let them know the dignity of work. Taxpayers will be better off. They will be better off. And it’s not going to be optional for governors. 

“Taking Medicaid coverage away from people who aren’t able to meet work requirements is not going to help them get a job,” said Hannah Katch, senior policy analyst with the Center on Budget and Policy Priorities. She saw the exchange between Kennedy and Azar, and is concerned that Azar is open to the idea of expanding Medicaid work requirements, given that similar policies with respect to cash welfare hurled people into further poverty.

Moreover, CBPP research shows that a majority of the roughly 25 million people nationally subject to Medicaid work requirements are already working. Even those who are already working run the risk of losing coverage because they aren’t working a set amount of hours each month — meaning, these people have low-wage jobs in which they don’t work continuously and for a consistent number of hours each month. And for those who don’t work, it’s due to illness, disability, or care-giving responsibilities. While some of these individuals might be exempt from the rule, the paperwork associated with the requirements could still trip them up.


“It’s deeply concerning to me,” Katch said of Azar’s remarks. “Because I think what is likely we’ll see in the demonstration projects that have already been approved is that many people will lose access to their health coverage who desperately need it.”

A study by the Government Accountability Office found that federal and state governments don’t rigorously evaluate the effects of Medicaid waivers, so it’s unclear whether work requirements will be properly analyzed by CMS.

In April, the Trump administration signed an executive order, promoting work requirements in public assistance programs. So far, the administration is encouraging states to implement work requirements, but it doesn’t force states to impose them.