Rural Health Policy Project

Child Health Providers and Advocates Ask HHS Secretary to Reject Work Requirements for Low-Income Parents

Today Georgetown University’s Center for Children and Families joined over 50 other national health care provider, research and consumer groups focused on children and families to send a letter to HHS Secretary Alex Azar raising concerns about the harm of work requirements for children and families, particularly in states that have not expanded Medicaid.

The letter points out how troubling it is that CMS would even consider approving such proposals that would lead to health coverage losses for many more parents and children at a time when the uninsured rate for children is already rising. The Trump Administration has done nothing to even acknowledge this harmful trend but is in fact considering policy changes that would make matters much worse.

The letter, which was spearheaded by the American Academy of Pediatrics, follows up on a letter that was sent a year ago today by a group of 44 organizations expressing similar concerns. HHS did not respond to that letter and apparently ignored the advice as CMS has continued to approve work requirements and the imposition of other barriers to Medicaid coverage.

As the letter highlights, evidence from Arkansas (the first state to implement work requirements) has made clear that severe coverage losses have resulted from the state’s work requirement, while doing nothing to reduce the barriers people face to improving their job status.

CMS is weighing decisions on whether to allow work requirements to be imposed on the very low-income parents and caregivers who qualify for Medicaid coverage in five non-expansion states (Alabama, Mississippi, Oklahoma, South Dakota, and Tennessee). The harm from work requirements would be even worse in these states because the parents and caregivers affected have extremely low incomes and are required to be covered by the Medicaid statute. In Alabama, for example, only the poorest parents and caregivers, those making 18 percent of the poverty level or less—$3,740 a year for a family of three or about $312 a month—now qualify. Imposing work reporting requirements in these states would result in coverage losses disproportionately affecting mothers, African Americans and families living in rural communities.

Children whose parents are insured are almost always insured themselves, whereas 21.6 percent of children whose parents are uninsured are also uninsured. When parents lose health coverage, it puts the whole family at greater financial risk.

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.