Don’t Abandon Medicaid Work Requirement

Cover art from 2014 JLARC report on Virginia’s array of workforce training programs. Another state report notes almost 860,000 served in 2017.

By Steve Haner

To Republicans who supported the 2018 decision to expand Medicaid services to more Virginians – and encouraged yes votes from reluctant colleagues — the promise to couple those benefits with pathways toward gainful employment was a key reason. The compromise has worked in other states as well. 

Now there are signs that the Northam Administration will only move forward with the training or education requirements if Uncle Sam provides the money, something that apparently has not been provided in any of the other states with Medicaid work requirements. It was a topic of discussion when the legislative money committees met September 16 and 17 and the issue was back in the Richmond Times-Dispatch Friday.

Virginia Secretary of Health and Human Resources Dan Carey wrote to the federal Centers for Medicare and Medicaid Services that without federal funding the state could not move forward with the work, training or community engagement requirements at this time. Just two weeks ago the Republican chairs of the state’s money committees told Carey directly they wanted Virginia to stay the course, even without federal dollars.

The Republicans who pushed the expansion bill through against opposition from their own party and political base are being betrayed. Behind the scenes they are hearing “we told you so” from those who doubted Democrats would compromise. Two delegates who went along have already paid the ultimate political price and lost primary nomination fights.

Any work or education requirement is anathema to many Democratic base voters. The requirement has been challenged in several states, successfully in some.

The Virginia program is outlined in legislation and in budget language. The clumsy acronym TEEOP stands for Training, Education, Employment and Opportunity Program. It applies only to unemployed working age, able-bodied individuals, a subset of Medicaid population (new and old). If you are within the age requirement but mentally ill, medically frail or institutionalized, it does not apply.

After all, many of the new Medicaid recipients are employed already. That was one argument for expansion, to cover low income workers not getting employer health care and struggling to buy it in the (not so) Affordable Care Act marketplace.

How much effort by the unemployed would be required to stay on Medicaid? It would phase in, with 20 hours per month (month!) required at three months and 80 hours per month after 12 months of benefits. Doing what? This is the list of options from the state budget section:

… participation in job skills training; job search activities in conformity with Virginia Employment and Commission guidelines; education related to employment; general education, including participation in a program of preparation for the General Education Development (GED) certification examination or community college courses leading to industry certifications or a STEM-H related degree or credential; vocational education and training; subsidized or unsubsidized employment; community work experience programs, community service or public service, excluding political activities, that can reasonably improve work readiness; or caregiving services for a non-dependent relative or other person with a chronic, disabling health condition. (Emphasis added).

Every month the state issues another news release about Virginia’s record low unemployment rate. Analyses of our state economy include concerns about a workforce shortage. Is it too difficult or even unfair to look at this pool of  able-bodied potential workers as an asset waiting to be developed? Is it cruel to view these benefits for them as mainly a bridge toward employment?

In 2017, various state agencies spent $340 million on workforce training alone, according to this report from the Virginia Board of Workforce Development. Much of that was within the Department of Education, and Medicaid recipients still in school are not covered by TEEOP requirements. But other programs seem tailor made for this population: GED programs, workforce certificate programs, apprenticeships, VEC programs tied to specific employers.

All told the efforts served 854,726 people that year. More than 400,000 were outside of the school-based programs. That did not include the new and highly regarded Workforce Credential Grant program at the community colleges, which might also serve some of this Medicaid population. Nor does it include Go Virginia money spent on training programs, a growing category for it.

The Department of Social Services already has workforce training efforts for recipients of Supplemental Nutrition (SNAP), Temporary Assistance for Needy Families (TANF) and for refugees being resettled. In 2017, $40 million was spent on 28,000 DSS participants, with about half reported as finding jobs. So, what works for SNAP, TANF and refugees is too difficult for Medicaid?

More than 60 percent of all 2017 workforce training money was provided by the federal government. It is not too surprising if the reaction in Washington was, gee, we send you more than $200 million a year on programs for this already and you want how much more? Why should we send you more to serve people already eligible for existing programs?

The Workforce Board operates with little attention, and recently changed its web addresses (to It took a call to a friend on the board to find the website and this report, which is now almost two years old. There still is not a unified system to track trainees and outcomes across the programs, which seem in the same set of disconnected silos as was found years ago by the Joint Legislative Audit and Review Commission.

Workforce training is just one of the options for these individuals. If the work, training, education or community service requirement for Medicaid does not go into place, the problem will not be lack of funding or lack of alternatives.