States May be Allowed to Invoke Work Requirements for Medicaid Eligibility

Long Island Medicaid eligibility consultingMedicaid provides health coverage to over 72.5 million Americans. Those covered include children, pregnant women, parents, seniors and those with disabilities. According to, Medicaid is currently the leading provider of health coverage in the United States.

Medicaid will automatically cover individuals who are deemed as low-income families, qualified pregnant women or children, and individuals who are receiving Supplemental Security Income (SSI). Starting in 2010, the Affordable Care Act made it possible for Medicaid to extend its coverage in order to cover all low-income Americans that were under the age of 65. This helped millions of Americans receive healthcare that they otherwise would not have been able to afford.

A person may be eligible for Medicaid if they meet certain financial requirements directly correlated to household size and the maximum income per year:

Household Size Maximum Income Per Year
1 $14,850
2 $21,750
3 $25,013
4 $28,275
5 $31,538
6 $34,800
7 $38,063
8 $41,325

On November 7, 2017, the Trump Administration announced its effort to include a work requirement in order to be eligible for Medicaid healthcare coverage. Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, stated that the administration is ready to approve proposals from states to require work or community engagement in exchange for a Medicaid coverage. Community engagement is defined in broad terms and can include activities that are unpaid such as:

  • Attending school
  • Volunteering
  • Attending job training
  • Searching for jobs
  • Caring for elderly relatives
  • Treatment for drug or alcohol abuse

This new requirement is in contrast with that of the Obama Administration which had turned down such proposals stating that a work requirement does not promote healthcare coverage and access to care.

Ms. Verma is of the understanding that while Medicaid does serve as a healthcare provider, it must also serve a higher purpose: “to help people rise out of poverty and government dependence.” She believes that many of those insured people who became eligible under the Affordable Care Act are able-bodied adults of working age who are choosing not to work because of the coverage afforded to them under Medicaid. Ms. Verma takes the position that the Obama Administration enabled people to stay in poverty by not making them look for jobs.

According to the Kaiser Family Foundation, at least eight states have already drafted waiver requests that would require work in order to be eligible for Medicaid. Those states include:

  • Arkansas
  • Arizona
  • Indiana
  • Kentucky
  • Maine
  • Utah
  • Wisconsin
  • New Hampshire

It is likely that the work requirement proposals from various states will be counterproductive as many able-bodied low-income families enrolled in Medicaid are currently employed. According to the Center on Budget and Policy Priorities, 75% of able-bodied enrollees live in a family with at least one worker. Able-bodied is defined as persons who are fit, strong, and healthy, i.e. not physically disabled. Additionally, according to, more than 4.6 million low-income seniors are covered by Medicaid as well as 3.7 million people with disabilities. By definition, seniors and disabled persons would be exempt from those Medicaid work requirements. Although there are no known work or community engagement requirements that seniors or disabled persons must adhere to, there are also no known exemptions.

In New York, there are no current plans for the state to propose a work requirement in order to be eligible for Medicaid coverage. If you wish to apply for Medicaid assistance, P&P Medicaid Consulting can handle the entire application process in order to ensure that you meet all requisite requirements. They can also alert you if New York changes its policy while you are undergoing the application process. For more information about the Medicaid application process or any of our other services or to schedule a consultation, contact our Long Island Medicaid professionals at (516) 541-4770 or fill out our contact form.

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