A total of 116 organizations led by Georgetown University CCF and the Center on Budget and Policy Priorities sent a letter to the Acting Secretary of HHS urging immediate action to protect people who rely on Medicaid for their health insurance and who live in states with proposed or approved section 1115 work and community engagement requirements demonstration projects. “These harmful and illegal requirements threaten health coverage for people with low incomes, especially those with chronic health conditions and people with disabilities, and would disproportionately harm Black people, especially Black women,” according to the letter cosigned by patient groups, health care providers, researchers, and consumer advocacy organizations.

The groups point out that the loss of health coverage caused by these punitive policies are inconsistent with the objectives of the Medicaid program and ask the Biden Administration to take three immediate steps to restore Medicaid to its purpose of preserving and protecting health coverage:

1. HHS should rescind the January 2018 State Medicaid Director letter that encourages states to pursue restrictions on Medicaid eligibility for low-income adults through section 1115 demonstrations. The guidance is counter to the principal objective of Medicaid, which is to provide health insurance to vulnerable populations and should be rescinded immediately.
2. HHS should deny all pending proposals to impose punitive work requirements on adults with very low incomes. The states with pending work requirement proposals are Alabama, Idaho, Mississippi, Montana, Oklahoma, South Dakota, and Tennessee, and Arizona is seeking to renew its approved work requirement policy. As a result of litigation, federal courts have vacated the approval of work requirements in Arkansas, Michigan, and New Hampshire. Many of these pending proposals exclusively target very poor parents, who are mostly women and disproportionately people of color. Swift action should be taken to ensure these proposals are rejected, especially in light of the ongoing pandemic, the economic recession, and the ongoing and historic impacts of structural racism.
3. To avoid further coverage losses and continued barriers to care, it is imperative that HHS withdraw approvals for all states with approved work requirement policies (Arizona, Georgia, Indiana, Nebraska, Ohio, South Carolina, Utah, and Wisconsin). Under the approved terms and conditions of the demonstrations, the Secretary can withdraw section 1115 waiver and expenditure authorities at any time if the continuation of those authorities is “no longer in the public interest or promotes the objectives” of Medicaid.

As readers of SayAhh! know, the issue of Medicaid work requirements is pending with a case related to Arkansas’ waiver scheduled to be heard in March. Stay tuned!