Based on concerns over Medicaid waiver applications that would require enrollees to work, search for work, or volunteer in order to qualify for government health coverage, the American College of Physicians (ACP) has submitted letters urging the Centers for Medicare and Medicaid (CMS) to reject proposals from Medicaid agencies in states, such as Arizona and Kansas, that would make eligibility contingent on whether a person is engaged in similar activities.

“While ACP appreciates some aspects of the states’ proposals, including expanding service coordination to assist participants with accessing affordable care, our policy firmly states that being employed or conducting job search activities should not be a condition of eligibility for Medicaid,” said Jack Ende, MD, MACP, president, ACP. “Instead, Medicaid waivers should focus on providing greater access to health services and keeping patients healthy, rather than requiring them to work in order to receive care.”

Whether or not a person is working, volunteering, or actively seeking a job, employment should never be a requirement to qualify for Medicaid, nor is it necessary. According to the Kaiser Family Foundation, 60% of nonelderly adults are already working, and 8 in 10 live in families with at least one person employed. Independent data show that the vast majority of Medicaid-enrollees who are not working have a legitimate reason for doing so, including being sick, disabled, taking care of a sick family member, pursuing academic studies, or unable to find a steady job. Surveys show that people who are unemployed report that having Medicaid coverage makes it easier for them to search for work, and those currently working say that coverage enables them to continue working.

Additionally, although ACP supports CMS’ goal to reduce administrative burdens through its Patients Over Paperwork initiative, work requirements could have the opposite effect on patients and physicians. Enforcing Medicaid work requirements can introduce more paperwork and impose more barriers to access that would prevent patients from receiving the health care they need. For example, while the waiver applications would allow for limited exceptions from work requirements if a physician certifies that a patient is “medically frail,” or if the patient can document that they fall into one of the other excepted categories, the process of having to submit (and regularly resubmit) such paperwork would create major obstacles to continued enrollment in Medicaid, causing many vulnerable patients to lose coverage.

ACP urges CMS to recognize that Medicaid work requirements would not just hurt patients, but physicians, too, as these requirements could make it harder for internists to advocate for their patients.

“Work requirements could put physicians between a rock and a hard place—forcing them to choose between following a state’s requirement that they document a patient qualifying as ‘medically frail’ to remain in Medicaid, yet if they are unable to do so, their patients would be harmed by losing their coverage,” said Dr. Ende. “Studies show that lack of health insurance is associated with poorer outcomes, including avoidable deaths. Physicians should never be put in the position of participating in a government-mandated process that could harm their patients.”