Book 1.indb 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).