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February 27, 2018

Are Medicaid Work Requirements Legal?

Author Affiliations
  • 1University of Michigan Law School, Ann Arbor, Michigan
JAMA. 2018;319(8):763-764. doi:10.1001/jama.2018.0958

On January 12, 2018, the Centers for Medicare & Medicaid Services (CMS) approved a waiver allowing Kentucky to impose a work requirement on some nondisabled Medicaid beneficiaries. Similar waivers are sure to follow. Supporters see work requirements as a spur to force the idle poor to work; opponents see the requirements as a covert means of withholding medical care from vulnerable people. Setting the policy debate aside, however, are work requirements legal?

The answer will hinge on whether a state’s waiver is a genuine “experimental, pilot, or demonstration project” that is “likely to assist in promoting the objectives” of the Medicaid program. That language comes from section 1115 of the Social Security Act, which was enacted in 1962 to allow experimentation in federal welfare programs. When Congress adopted Medicaid in 1965, it amended section 1115 to cover the new health program.1