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Medicaid work requirements: a really bad idea for increasing employment
  1. Kimberly Danae Cauley Narain1,2,
  2. Frederick J Zimmerman2,3
  1. 1 Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
  2. 2 Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles, California, USA
  3. 3 Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, USA
  1. Correspondence to Dr Kimberly Danae Cauley Narain, UCLA Division of General Internal Medicine and Health Services Research (GIM/HSR), Los Angeles CA 90024, USA; knarain{at}

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In January of 2018 the Centers for Medicare and Medicaid Services (CMS) announced that it would be granting waivers to states to impose either work or community engagement requirements on non-disabled, working-age Medicaid beneficiaries, based on the idea that such requirements would ‘promote better mental, physical, and emotional health’ and help families ‘rise out of poverty and attain independence'.1 To date, four states have approved waivers (Arkansas, Indiana, Kentucky and New Hampshire) and seven states have pending waivers with CMS.2 These waivers typically require that individuals work anywhere from 20 to 30 hours per week or engage in some specified activity to maintain eligibility for Medicaid benefits, with exceptions made, in some cases, for the elderly, pregnant women, primary caregivers, students and those with substance-abuse disorders or serious physical illness. There are good reasons to fear that these waivers will not improve health or foster economic self-sufficiency among current Medicaid beneficiaries as CMS suggest but instead will lead to worse health outcomes and less economic security among individuals who lose access to healthcare as a consequence of these waivers. These concerns were one reason why implementation of the KY waiver was halted. In the case of Stewart v. Azar, the court found that in the approval of the waiver the Secretary of Health and Human Services failed to consider the waiver’s impact on providing affordable health coverage to the low-income populations identified by Congress …

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  • Contributors Both authors conceptualised the editorial, drafted the manuscript and contributed to the final editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.