ASPE and CPSD oppose Medicaid work requirements

The majority of non-elderly, adult Medicaid recipients are already either working or are caregivers for family members. Medicaid work requirements are a thinly-veiled attempt to reduce the number of people on Medicaid!


The Collaboration to Promote Self Determination (CPSD) and the Association of People Supporting Employment First (APSE) are organizations dedicated to the employment of people with disabilities.  With needed supports and services, primarily provided through Medicaid, people with disabilities have shown they can successfully work in jobs alongside their peers without disabilities.

Our organizations are committed to advancing policies that have been shown to help people work.  This includes increasing access to supported employment services funded through Medicaid, providing job training, increasing opportunities for apprenticeship and work-based learning experiences in higher education, and addressing transportation barriers.

Leadership in Congress and this Administration have said they are committed to expanding opportunities for employment of all Americans.  Yet, instead of investing in expanding programs that help people work, the Administration and Congressional leaders have been focusing on “work requirement” policies.  In January 2018, the Centers for Medicare & Medicaid Services (CMS) released guidance authorizing states to impose work requirements on Medicaid participants and, over the last several weeks, has approved requests from two states (Kentucky and Indiana) to include work requirements in their Medicaid programs.

Work requirements are not about providing supports to help people get a job or about addressing barriers to employment.  In fact, the CMS guidance letter specifically states that Medicaid funds cannot be used to provide assistance to participants in meeting the work requirements through job training, employment services, or childcare.  And CMS denied Indiana’s request to use Medicaid funding to help participants meet their work requirement by providing them skills assessment, training and assistance with searching for a job.

Instead, Medicaid work requirements are a thinly-veiled attempt to reduce the number of people on Medicaid.  Work requirements mean that people who are eligible for and rely on Medicaid will lose access to healthcare if they can’t meet the requirements.  Threatening the loss of healthcare has not been shown to be effective in increasing employment.  In fact, people who have access to healthcare and are healthy are more likely to be able to work.  Further, the vast majority of people on Medicaid are already working or are caregivers, including of people with disabilities.  According to the Kaiser Family Foundation, 60 percent of Medicaid participants are already working; 12 percent are not working due to caregiving; and an additional 14 percent are not working due to illness or disability.

People with disabilities and their families will be harmed by work requirements.  While CMS claims that these policies will only apply to “able-bodied” individuals, only people who qualify for Medicaid because they qualify Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) are currently counted as “disabled.”  Millions of other people with disabilities who qualify for Medicaid through other pathways will be subject to work requirements without access to the very Medicaid supports that enable other participants to find and sustain jobs.  Further, many caretakers of people with disabilities will forced to choose between accessing healthcare or taking care of their loved ones.

CPSD and APSE oppose Medicaid work requirements as an unconscionable attempt to decrease the number of otherwise eligible people relying on Medicaid for healthcare and other supports.  We call on policymakers and the Administration to show a commitment to employment by instead expanding access to the job training and employment supports and services that have been shown to help people get and retain jobs.  We also encourage Congress and the Administration to expand opportunities for employment of people with disabilities and address their barriers to employment, including by implementing recommendations from the recent report to Congress and the Labor Secretary from the Advisory Committee on Increasing Competitive Integrated Employment for Individuals with Disabilities.

The Collaboration to Promote Self Determination is a collaboration of national organizations representing people with disabilities and their families committed to educating Congress and federal agencies about what people with disabilities need to rise out of poverty and live more independently.  We advocate for major systemic reform of the nation’s disability laws and programs so people with disabilities can become employed, earn competitive wages, live independently in inclusive communities, and rise out of poverty.

The Association of People Supporting Employment First (APSE) is the only national membership organization focused exclusively on integrated employment. Through advocacy and education, APSE advances employment and self-sufficiency for all people with disabilities.

CPSD & APSE Statement on Medicaid Work Requirements

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