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Commonwealth Forum: Should Pennsylvania Enact 
Work Requirements for Medicaid Recipients?

YES

The notion that states might place work requirements on Medicaid recipients 
has thrown liberals into a tizzy. In attempting to point out the supposed cru-
elty of conservatives in adopting such a policy, those on the left call attention 
to the elderly and child beneficiaries who are supposed to somehow now find 
jobs. But these groups are not the target of work requirements, and liberals 
know it. The real targets of work requirements, and the only ones, are able-
bodied adults who can work but do not. Conservatives do not want to take 
health care away from grandma and babies, just make sure those who can 
work, do so. The phrase “work requirements” itself is rather misleading. Yes, 
work is part of the policy proposal. But recipients of Medicaid could also 
prove they are caring for someone else, actively seeking employment, or even 
volunteering. It’s not asking too much for someone to receive taxpayer-
funded benefits in exchange for giving back to society. No one should be so 
entitled to tax-funded programs as to earn them by sitting on the couch 
all day.

The implementation of work requirements will also help stem the growth 
of Medicaid spending at the federal and state level. Health-care costs are 
already the largest part of many state budgets. Paying to cover the health 
insurance costs of able-bodied adults who choose not to work comes at the 
expense of further investment in central government functions like educa-
tion, public safety, and infrastructure. Saving taxpayers from the need to 
spend on the indolent will lead to smarter budgets. And in the meantime, 
reducing the Medicaid rolls should also lead to lower premiums in the pri-
vate market.

Calling for the imposition of work requirements on Medicaid recipients 
is not punishing the poor. It is returning the program to its original mission 
of helping the disabled elderly, pregnant women, and children.



NO

Since early 2018 the Centers for Medicare and Medicaid Services (CMS) has 
allowed states to apply for waivers to place work requirements on Medicaid 
recipients. Policy makers in Pennsylvania are debating whether to apply for 
a waiver. Advocates claim that work requirements will encourage people to 
find jobs that will lift them out of a cycle of dependency.

Realistically, work requirements would not have the desired effect. Most 
able-bodied Medicaid recipients are already working in low-wage jobs that 
create their eligibility for benefits. Further, for many people the only acces-
sible jobs are in hospitality, restaurants, or retail, which are often part-time 
or have fluctuating hours from week to week. Consequently, under provi-
sions being debated in Pennsylvania, a person might be eligible for Medicaid 
one month because the required twenty hours a week at a job was fulfilled, 
but then lose benefits if the hours at work dipped under that amount in ensu-
ing months.

A sizeable portion of Medicaid recipients are elderly, disabled, suffer 
from mental illness, or are children. These populations would be exempt 
from the work requirement, but would be required to file time-consuming 
paperwork to keep their benefits. These are vulnerable groups who often lack 
the education and resources to deal accurately with difficult bureaucratic 
processes. Consequently they could lose their access to health care even 
though they are still eligible. This would also apply to working recipients of 
Medicaid who would have to follow an even more arduous application pro-
cess to keep benefits.

Finally, the Kaiser Family Foundation estimates that only 6 percent of 
Medicaid recipients are currently not working or eligible for an exemption. 
However, under the CMS waiver program, states may not use Medicaid 
funding to help these individuals receive assistance in finding a job. Without 
added expenditures from states for these services, many people will find 
themselves both unemployed and without health insurance. At the end of 
the day, providing health care saves money in the long run by dealing with 
health issues before they become emergencies. These advantages far out-
weigh the benefits of work rules that may catch a few people abusing the 
system.



For More Information

The centers for Medicare and Medicaid services (cMs) (https:// www  
.cms .gov) is part of the federal Department of Health and Human Ser-
vices. Their website has information on many different health-care is-
sues, including the obvious Medicare and Medicaid.

The Kaiser family foundation (https:// www .kff .org) is a nonprofit focused 
on health care in the United States and the U.S. relation to the rest of the 
world on health-care topics.

The Pennsylvania Department of Health services provides information on 
Medicaid as well as other health and wellness programs supported by the 
state. The department’s website also provides county-level data on pro-
grams (http:// www .dhs .pa .gov/ learnaboutdhs/ data -dashboard/ index 
.htm).

From Pennsylvania Politics and Policy: A Commonwealth Reader, Volume 2. Edited by
Michelle J. Atherton and J. Wesley Leckrone (Philadelphia, Temple University Press,
2019).




