Tennessee governor to sign Medicaid work requirement funded by welfare dollars

Gov. Bill Haslam said work requirements might build support for Medicaid expansion. But it hasn't.

(Photo by Chip Somodevilla/Getty Images)
(Photo by Chip Somodevilla/Getty Images)

A philosophical change to the country’s largest public health insurance program is underway, as states one-by-one try to implement Medicaid work requirements. Tennessee is the latest state to try to make work conditional of Medicaid eligibility. At least 22,300 are expected to drop health insurance, according to the state’s own estimate.

On Thursday, the state Senate sent Gov. Bill Haslam (R) a bill that directs Tennessee to submit a federal waiver to impose work requirements for “able-bodied working age adult enrollees without dependent children under the age of six.” Haslam recently told the Tennessean he would sign it.

And should the federal government approve, Tennessee would use federal welfare dollars from the Temporary Assistance for Needy Families (TANF) program to finance the implementation of work rules.

The federal government has already okay-ed work requirements in three other states (Kentucky, Indiana, and Arkansas), with Arkansas beneficiaries officially needing to comply with the requirement in June. Once Haslam signs the measure, Tennessee joins 11 other states that are currently awaiting federal approve. Other states are trying to join the lot; the Michigan Senate approved and sent a 29-hours-a-week work requirement to the House on Thursday.


Tennessee did not expand Medicaid, a policy under the Affordable Care Act that allows states to cover all individuals with household incomes below 133 percent of the poverty level. As a result, the work requirement would affect parents and caretakers making less than 103 percent of the federal poverty level. State Senate Democratic Caucus Chairman Jeff Yarbro tried to attach a Medicaid expansion provision to the work requirements bill on Thursday, but Senate Clerk Russell Humphrey ruled he could not do this, according to the Time Free Press. In February, the governor said that work requirements could enable support for Medicaid expansion, but it hasn’t yet.

At least 300,000 enrollees are affected by Tennessee work requirements, according to a state fiscal review committee. Half would already comply, as they’re also enrolled in TANF or the state’s food share program which has a work requirement. The state expects this rule will affect 86,439 when they account for exemptions. The state also notes that 49,270 (57 percent) of the 86,439 are already working.

The state’s data shows most Medicaid beneficiaries who can work, are working. A reason many lawmakers, including the governor, support this provision is because there’s a perception that enrollees are not working and that’s why they’re on Medicaid. “We have thousands of unmet job needs in Tennessee right now. So this is an environment where people can go fairly easily and meet those qualifications,” Haslam told the Tennessean in March when asked if he supports work rules.

Even Medicaid beneficiaries who are working may drop coverage because they fall short of the stringent requirement, according to an analysis by the Center on Budget and Policy Priorities. These people work in food service or in seasonal jobs, for example, and have fluctuating hours. Added paperwork associated with the new rule could also trip up people who technically fulfill the requirement.

The state does expect 22,301 to drop health insurance, for reasons they’re unsure of because there is a “lack of data related to this population.” Lawmakers don’t expect the work requirements bill to be fully implemented until July 2020.