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.

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22 responses to “Don’t Abandon Medicaid Work Requirement”

  1. Jane Twitmyer Avatar
    Jane Twitmyer

    WOW! Sounds like a lot of complicated bureaucracy required to keep track of continuing eligibility, something conservatives should abhor.
    Health care for all could be available and we could ease up on ER visits by people without insurance. How about that Medicare Choice option?

    1. Jane Twitmyer Avatar
      Jane Twitmyer

      Hope the commenters have seen and read the WashPost’s article on the expansion of Medicaid today, Tuesday. While the information is just coming in, it looks like serving the health of the un and underserved in an orderly way actually saves everyone money in addition to saving lives and improving, in some cases dramatically, the health of those formerly underserved people. Evidently this is especially true with chronic diseases like diabetes, and asthma.

      Regarding the issue of health care as a ‘reward’ or a right. Certainly no one on the left thinks there is a delineated ‘right’ in the Constitution for the government to provide health care insurance for everyone. We simply think that our society, our community of neighbors, is a better place, and we are all are responsible to see that everyone has access to health care. What Healthy Michigan appears to have found out is that providing that healthcare, at a price that is reasonable and fair to ask the recipient to pay, is both the compassionate and the financially prudent thing to do.

      The left would also say that the US is not a Banana Republic because we require everyone to go to schools that are paid for by the community. In CT, 30 years ago, we had a formula that supplemented the local community’s ability to pay for the schools, their size of their local property tax base, with additional state funds. An educated population benefits us all.

      And finally, we are finding out that, although we are a nation of laws, there seem to be many who think those laws just don’t apply to them. The same can be said of the corporations that ignore science, rationalize their harmful actions and politically control, if they can, the passage and content of any governmental regulation. Call it ‘political correctness’ if you must. I think a better word is fraud.

  2. TooManyTaxes Avatar

    The Democratic Party, once the champion of working people, is the party of dependency. This if for two reasons. A large dependent population keeps many people with advanced degrees employed by government and nonprofits. And the large dependent population, used to getting free things will be inclined to vote for Democrats.

  3. Jane Twitmyer Avatar
    Jane Twitmyer

    Facts and figures?

  4. LarrytheG Avatar

    It’s not clear to me what Medicaid recipients they want to work. Under the original Medicaid, almost no able-bodied adults are eligible.

    Under the expansion – it was explicitly designed for people who did work but did not make enough to afford insurance.

    Some other states to provide Medicaid to non-working able-bodied adults and yes – they want to require work but in Virginia – I’m not clear exactly who they are talking about and whether it’s original MedicAid or the Expansion.

    Here are the qualifications for original Medicaid:

    Medicaid is the state and Federal partnership that provides medical coverage to eligible needy persons.

    In order to qualify for this benefit program, you must be a resident of the state of Virginia, in need of health care/insurance assistance, and whose financial situation would be characterized as low income or very low income. You must also be a U.S. national, citizen, or have satisfactory immigration status. To qualify for this benefit, you must:

    Be over the age of 64; or
    Be pregnant or have a child 18 or under; or
    Be blind or disabled; or
    Have a child, parent, or spouse in your household who is blind or disabled”

    Are they talking about work requirements for Women who have children?

    As you can see – if you are not caring for a child or disabled – you have to be OVER 64 to get Medicaid.

    So can someone clear this up and identify who they want to work?

    1. djrippert Avatar

      Here is the website I found:

      I see no requirement that Medicaid recipients be over 64. Isn’t that Medicare?

  5. LarrytheG Avatar

    re: the Dems and “dependency”.

    the truth is that anyone who currently has employer-provided are themselves “dependent” on the govt to insure the insurance company must insure them – regardless of their health – and for the same premium as others regardless of health.

    If the govt took that away -many people who currently have employer-provided – would lose it or the premiums so high they could not afford it. Just about anyone with a chronic condition, heart disease, diabetes, etc would not be insured unless the govt required the insurance companies to insure them.

    Then when you retire – your private insurance would go away and without Medicare – most seniors would die fairly quickly from conditions related to aging.

    It’s beyond me that those who actually are lucky enough have employer-provided health insurance do not recognize that many would have it only because of the govt. They are just as dependent in reality but they would deny others access.

    1. TooManyTaxes Avatar

      Wrong in so many ways. Employer-provided health insurance is part of one’s compensation. It’s earned. The plan can be changed and, sometimes, eliminated. But it’s compensation. It doesn’t come from the government unless you are a government employee and then, only as compensation.

      The push for employer-provided health insurance came during WW2 when wages were controlled as part of the war effort. The Roosevelt Administration said that, as an offset of sorts, employers could provide health care coverage to employees without violating the wage controls. Many did. Neither FDR nor Congress made any attempt to tax it. Nor have their successors. And the employer costs are a tax deductible expense. But employees earn their coverage. It’s not a gift from Uncle Sam.

      And if the employer contributions were made taxable, so should the cost for Medicaid. Fair is fair.

      And there are many, many people over 65 who only have Medicare Part A and then only because it’s required by law. There are many people who are 65 and older who only have their employer-provide health insurance and not any other Medicare Part coverage. For example, many retired federal employees, when they do the math, find out that not taking Medicare Part B but retaining their government plan saves them money.

      And health care is a right. What is the source of that right? And if some people can make up rights so can others. How about a right to refuse to pay the costs of public schools when one has no children in school? Or a right to dump anything on one’s land? We are a nation of law despite the efforts of the left to make us a politically correct dictatorship of the proletariat.

  6. LarrytheG Avatar

    With regard to the “silos” I totally agree and it seems to be endemic with regulation of entitlements , education, environmental protection and more but there is some super-simplistic thinking going on about people who care for others – kids, handicapped and the elderly and the idea that they should “work” for their govt/taxpayer aid.

    Most caregivers would LOVE to work – to get a change from the 24/7 nature of their caregiving life – but it’s going to take more than “training” – and we won’t fix it by requiring them to “work”.

  7. Steve Haner Avatar
    Steve Haner

    It is not a work requirement, although that becomes the shorthand. It is a work/get some education/get in a training program/act as a caregiver in some circumstances/community service program. Several options. No requirement to actually have a job any any point….I really have been surprised by the hostility to the idea, but it is there. I think it largely comes from those, and Jane went there, who think health care is just a right.

    You weren’t saying that I’m advocating denying access, were you Larry? I’m one of those who encouraged some R legislators to go for this, and now I’d like to remind the Democrats that this was part of the package and they should honor the agreement to include pathways to employment for those able to work.

    1. LarrytheG Avatar

      No I’m not saying you were in favor of denying access but I DO THINK the GOP comes across that way on some of this and that’s why there is “hostility”. If it’s not clear to me what they want – I suspect it’s not clear to others and the GOP has a history themselves of wanting to deny services to those in need …

      Remember the idea that we “give” women with kids free childcare so they can work but they don’t want to fund the free childcare? Chicken/Egg?

      if we did fund care-giving so that those who give care can work………. does that really make sense? Easy to do the simplistic “reasoning” – harder to deal with the whole enchilada…

    2. LarrytheG Avatar

      Here’s the thing – the expansion has nothing to do with the original MedicAid and the GOP is basically using the expansion as leverage to change the original Medicaid… right?

      This is never really made clear in these discussions.

      Why do that? That’s the part that makes it sound like the GOP doesn’t believe people who receive Medicaid – deserve it – they want to make them “earn” it.

      I’m actually not that far away from their view on it but I think it should be up front – they should own it not play stupid and partisan games about it.

  8. djrippert Avatar

    Why is this a surprise? Just more plantation mentality from a scion of plantation society. If Northam has to lie, cheat or steal to buy votes then he will lie, cheat and steal. His family stole the labor of slaves to build their fortune and Ralph will steal the money of working Virginians to enhance his political power. If that means giving away “free stuff” paid for by other people’s money – so be it. If that means dropping a work or training requirement – so be it. The people paying are too busy to notice and the freeloaders will remember to vote for the party of “free stuff”. Heaven forbid that people receiving “free stuff” be asked to at least try to get off the dole. The Northams have been stealing from one group of Virginians or another for centuries. Nothing new.

    1. LarrytheG Avatar

      that’s an odd line of “reasoning” given that Dems and Northam have been and are accused of serving up more and more freebies…something most folks with a plantation mentality usually are opposite of………they argue about the “victim” entitlement meme, right?

      1. djrippert Avatar

        The members of Virginia’s plantation society have never respected the rights of others. They enslaved Africans, disenfranchised people from western Virginia (now West Virginia), fought and lost an immoral war that saw hundreds of thousands of poor people (who never owned slaves and never would) die for their plantation mentality. They closed the public schools rather than integrate those schools. Now they want political power and are more than happy to spend your money to get it.

        If we’re going to talk about reparations for slavery let’s start by confiscating the land owned by former slaveholding families like the Northams, sell that land and use to proceeds to finance free college for Virginians who can demonstrate that their families were once held as slaves.

        The whole plantation society mentality is predicated on taking things from other people to enrich themselves. Freedom from the slaves for tobacco. Money from middle class Virginians for political power. Modern day Tories they fancy themselves as some kind of royalty. I guess “sic semper tyrannis” never really sank in for these folks.

        1. LarrytheG Avatar

          boy, you ARE on a tear on this……….. 😉

          but you do aptly describe a particular mindset that is still around~

          1. djrippert Avatar

            It’s one thing to build a 60 foot tall statue of Robert E Lee on donated land in 1890. It’s another thing altogether to build a statue of Harry F Byrd, Sr on Capitol Square in 1976. Worse yet, the statue to the racist Byrd is described on a plaque in typically dishonest Richmond rhetoric. It reads in part, “governmental restraint and programs in the best interest of all the people of Virginia.”

            Massive resistance was in the best interests of all the people of Virginia? Trying to ruin Oliver Hill’s career and get him disbarred was in the best interests of all of the people of Virginia? Disenfranchising African Americans and poor white people with poll taxes and literacy tests was in the best interests of all the people of Virginia? Byrd is shown holding the federal budget. As if he was a mere accountant trying to keep the books straight.

            Again, this was done in 1976 not 1876.

            Plantation society is alive and well in Virginia and its capitol is Richmond.

            If Ralph Northam wanted to make a visible difference regarding racial harmony he’d order the statue of that racist Harry F Byrd removed. But, of course, Northam is part of Virginia’s plantation society.


  9. Jane Twitmyer Avatar
    Jane Twitmyer

    Thanks for the Roanoke paper article.
    AND I like the idea of of just changing the plaque, not moving the statue… “The Capitol Square Preservation Council is undertaking an initiative to retool the square’s visitor experience. As part of this effort, the current Byrd plaque, with its misleading and incomplete narrative, should be removed and replaced with an interpretation that tells the true story of Harry F. Byrd.”

  10. I’m still digging through our U.S. Constitution trying to find where the federal government is authorized to spend money on medicaid.

  11. Steve Haner Avatar
    Steve Haner

    Well, that barn door has been wide open a long time. It’s a pretty good example of: “Well, if we do this for those folks, won’t we have to do this next?” Harry Byrd fought it, but how is he remembered? 🙂 I’m not entirely sure that’s unrelated.

  12. […] Recipients Keep Growing?  Following the recent legislative dust up over Virginia’s nascent work or training requirement for certain Medicaid recipients, the Commonwealth Institute for Fiscal Analysis issued a new […]

  13. […] thousands of Virginians” to drop off Medicaid. Neither is legitimate, as explored previously on Bacon’s Rebellion.  It also could cause tens of thousands to find their way to paying jobs with employer-provided […]

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