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From Health Law Daily, April 11, 2018

Executive Order promotes work requirements for public assistant programs to reduce poverty

By Susan Smith, J.D., M.A.

The federal government should do everything within its authority to empower individuals by providing opportunities for work, including investing in federal programs that are effective at moving people into the workforce and out of poverty, according to the statement of policy in an Executive Order signed by President Trump on April 9, 2018. The order directs relevant federal agencies to improve employment outcomes and economic independence and eliminate policies or programs that are not succeeding.

Facts and comments on public assistance programs. An April 10, 2018, a White House briefing noted that today, there are a record 28 million able-bodied adults on Medicaid, quadruple the number in 2000. In 2016, over 16 million able-bodied adults were enrolled in the Supplemental Nutrition Assistance Program (SNAP). In January 2018, over 74 million Americans were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), a 29 percent increase over the 2013 baseline period.

U.S. Secretary of Agriculture, Sonny Perdue, said, "providing people with the training and skills they need to find gainful employment will help place them on the path to self-sufficiency and restore the dignity of work. It’s the right thing to do for our people, just as it’s the right thing to do for American taxpayers." Secretary of Labor Alexander Acosta noted that "President Trump is working to create jobs and opportunity for the American people, with nearly 3 million jobs created since Election Day 2016. A good job provides a pathway to economic independence. The President’s Executive Order takes an important step to help all Americans achieve self-sufficiency through quality, family-sustaining employment."

Rebecca Vallas, vice president of the Poverty to Prosperity Program at the Center for American Progress, tweeted: "Trump's executive order served to reinforce myths about poverty in the U.S. By using dog-whistle terms like 'welfare,' Trump's trying to paint people who turn to Medicaid, SNAP [Supplemental Nutrition Assistance Program], and other public programs as Reagan's mythical 'welfare queen' -- so we don't notice that he's coming after the entire working and middle class."

Principles of Economic Mobility. The order spells out nine "Principles of Economic Mobility," to guide federal agencies that administer public assistance programs to effectively reform the welfare system, as follows:

  • improve employment outcomes and economic independence;
  • promote strong social networks, including through marriage as a way of escaping poverty;
  • address the challenges of finding and maintaining employment;
  • provide flexibility to state, local, and tribal governments to tailor programs to the needs of their communities, while ensuring accountability for achieving outcomes;
  • reduce the size of bureaucracy and streamline services to more effectively use of resources;
  • reserve benefits for people with low income and limited assets;
  • reduce wasteful spending by eliminating or consolidating duplicative federal programs;
  • create a system to update the federal government and other states and localities on state, local, and tribal successes and failures;
  • empower the private sector to develop and apply locally based solutions to poverty.

Federal government’s responsibilities. The order requires the federal government to enforce work requirements required by law and strengthen requirements that promote obtaining and maintaining employment to move people to independence and ensure accountability. The federal government must review federally funded workforce development programs, invest in effective workforce development, and empower state, local, and tribal governments as well as the private sector to administer and manage public assistance programs and design and implement such programs.

The Secretaries of Treasury, Agriculture, Commerce, Labor, HHS, Housing and Urban Development, Transportation, and Education must review all of their agencies’ regulations and guidance documents related to waivers, and exemptions or exceptions for public assistance program eligibility requirements to determine whether such documents are consistent with the principles in the order and review their agency’s public assistance programs that require work for receipt of benefits and determine if the enforcement of such work requirements are consistent with federal law and the order. Within 90 days of the order, the Secretaries must submit reports to the Director of the Office of Management and Budget (OMB) and the Assistant to the President for Domestic Policy and a separate report to the President. The results of the recommendations that propose drastic changes to programs like Medicaid, food stamps, and Temporary Assistance for Needy Families (TANF).

Medicaid waivers and work requirements. The Trump Administration’s intentions to broaden the utilization of Medicaid waivers provides for states’ inclusion of work requirements in waiver applications. On January 11, 2018, the Trump Administration issued a letter to help states "test community engagement for able-bodied adults." CMS recommends that a wide range of activities satisfy states’ work requirements, such as career planning, educational programs, job training, caregiving, and volunteer or tribal employment (see Trump’s CMS endorses Medicaid work requirements, January 11, 2018). On January 12, CMS approved Kentucky’s Medicaid waiver, the first approval of a Medicaid waiver containing work requirements. As of January 2018, eight other states—ArkansasArizonaIndianaKansasMaineNew HampshireUtah, and Wisconsin—had pending waiver requests which, if approved, would require work as a condition of Medicaid eligibility for nondisabled, working-age adults in expansion or traditional Medicaid populations (see HHS lets states open doors on Medicaid waivers, January. 19, 2018).

In the New England Journal of Medicine, Boston University professor Nicole Huberfeld, whose scholarship focuses on the role of federalism and spending power in Medicaid, questioned the legality of the administration’s new interpretation and policy change. Huberfeld argues that work requirements are inconsistent with purposes of the Medicaid Act, which she says has the goal of providing eligible beneficiaries with medically necessary care, not ending dependence on the government like welfare programs do (see Are Medicaid work requirements illegal?, March 6, 2018).

MainStory: TopStory WhiteHouseNews CMSNews MedicaidNews

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