Republican touts Medicaid work requirements — by citing states where they didn't work

As Republicans debate a way to cut spending to implement President Donald Trump’s tax cuts, they are considering adding work requirements to Medicaid. To support the idea, one GOP lawmaker cited two examples: However, those were instances in which Medicaid work requirements went wrong.

“There are already tens of millions of Americans who are subject to work requirements. This is not a new concept,” Rep. Dusty Johnson (R-S.D.) told NOTUS in a piece published Monday. “[Work requirements] are fantastically effective in helping people… The evidence suggests that overwhelmingly, the impact, on average, is positive.”

He listed Maine and Arkansas as examples of where work requirements went well. But in Maine, NOTUS’ Emily Kennard pointed out the potential work requirements were actually rejected. Republican Gov. Paul LePage had requested them, and then-President Trump approved them. Later, Democratic Gov. Janet Mills put a stop to the plan. And in Arkansas, a judge ended up blocking the program.

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“Maine’s low unemployment rate, its widely dispersed population, and our lowest per capita income in New England make mandates – without appropriate supports like vocational training and specific exemptions for groups like people undergoing treatment – problematic,” Mills wrote a 2019 letter to U.S. Centers for Medicare & Medicaid Services. “We believe that the likely result of this [requirement] would leave more Maine people uninsured without improving their participation in the workforce.”

In Arkansas, data “tells a much different story than the case Johnson made,” Kennard writes. The only state to implement such requirements, Medicaid recipients age 30 to 49 were notified in 2018 that they were required to work 80 hours per month. Almost 17,000 people lost their coverage as a result. However, a study published by the New England Journal of Medicine found that 97 percent of respondents were eligible under these new requirements.

“Studies found that beneficiaries were confused by the policy, and some lacked internet access to report their work hours,” Kennard adds.

By 2019, a federal judge had stopped the Arkansas program. An appeals court struck down the requirements in 2020. “Failure to consider whether the project will result in coverage loss is arbitrary and capricious,” the 2020 ruling said.

Kennard writes: “While it did not increase beneficiaries’ workforce participation, it did increase medical debt, and delay care for more than half of those disenrolled: 64% of people affected delayed taking medication because they couldn’t afford it. The CBO [Congressional Budget Office] concluded in 2023 that “the employment status of and hours worked by Medicaid recipients would be unchanged” by work requirements, but it would lead to more uninsured Americans. The CBO came to that conclusion in part thanks to data from Arkansas.”

But when presented with that information, Johnson said the CBO should not “draw conclusions on the basis of one state’s experience.”