(WASHINGTON, D.C.) – Congressman Jamie Raskin (MD-08) sent a letter to Secretary of Health and Human Services (HHS) Alex Azar today expressing his opposition to the Trump Administration’s actions that will allow, for the first time in the history of the Medicaid program,  a work requirement as a condition of coverage.  Rep. Raskin is deeply concerned that linking health coverage to a work requirement will undermine access to health care, and contradict the plain text and purpose of the law.  Raskin joined 172 members on the letter to Azar.       

The letter comes after the Centers for Medicare and Medicaid Services (CMS) announced last month that the agency would allow states to require a person to work in order to have access to Medicaid.  One day later, CMS gave unprecedented approval to a so-called Section 1115 waiver request from Kentucky allowing it to include work requirements for Medicaid coverage.  CMS has also approved a work requirement waiver for Indiana.  These types of requirements have routinely been deemed by previous administrations as unlawful.

“Medicaid demonstrations that adopt restrictive conditions on eligibility like work requirements, mandatory drug testing, lock-out periods, coverage time limits, disenrollment and onerous premiums and cost-sharing threaten to impede rightful access to care for Americans, a consequence that contravenes the statute and Congress’s longstanding intent in creating the Medicaid program,” Raskin wrote to Azar with the other House Democrats.  “We urge you to faithfully administer the Medicaid Act and to reject and reconsider Section 1115 demonstration requests that jeopardize the health and financial security of Medicaid beneficiaries.”

Congress intended for Section 1115 waivers to be issued by CMS to states to conduct projects that fundamentally advance Medicaid.  Over 30 states have taken advantage of this flexibility by conducting demonstrations that improve health care access, coverage, or delivery. 

In stark contrast, waivers like the one approved by the Trump Administration in Kentucky and Indiana undercut and exceed statutory authority given to the Secretary of HHS. Raskin and other House Democrats wrote that CMS continues to take actions demonstrating the agency’s intent to approve demonstration waivers that the Democrats believe would bar eligible individuals from Medicaid through restrictive and onerous eligibility requirements. 

“Such actions to tie health coverage to work are motivated purely on the basis of ideology and mistaken assumptions about what Medicaid is and who it covers,” Raskin and other House Democrats continued in their letter.  “The reality is that CMS’s recent actions ignore a fundamental truth: most of those who can work, are working, but may fall through the cracks and lose their coverage due to harsh and inflexible implementation of this ideologically-driven policy.”

Medicaid is a part of the lives of more than 70 million elderly, low-income, disabled adults and children that depend on the program to help provide them piece of mind and financial security to move their families out of poverty.  Raskin wrote imposing such policies on Medicaid families, who are generally living on a budget of roughly less than $15,000 per year, is not only punitive but also counterproductive.  At their core, policies such as work requirements assume that individuals should work in order to have health, when the opposite is plainly true: health is essential for successful employment.

Full text of the letter can be found here.