Work Documentation Requirements for Medicaid: 4 Things Texans Should Know

Earlier this year, the Trump Administration announced that it would consider proposals from states to add work documentation requirements and other new restrictions to Medicaid. The Administration has now approved versions of these proposed “waivers” from Arkansas, Indiana, and Kentucky.


It’s important to remember the critical role that Medicaid plays in so many people’s lives. Thanks to Medicaid, children with Down syndrome or speech delays can get the therapy they need to reach their potential. Young students get eyeglasses to see the board at school. Parents receive treatment for cancer, diabetes, or mental health challenges. Our neighbors can break their addiction to opioids or other substances. Seniors continue to live a healthy and dignified life. And – in the midst of a maternal mortality crisis – more women have healthy pregnancies and healthy babies.

Because of the importance of Medicaid, a wide variety of experts – including these 44 organizations – have expressed deep concerns about work documentation requirements and other new proposals to restrict Medicaid.

Fortunately, Texas has not applied to establish work documentation requirements. Applying these requirements to the current Medicaid population in Texas — or to a larger Medicaid population if Texas accepted Medicaid expansion funding from the federal government — would be very concerning.

Here are some of the key concerns about imposing work documentation requirements in Texas Medicaid:

1. It’s a Policy to Cut Health Care, Not Promote Work

Helping people work is important. However, the way to do that is to address barriers to work such as poor health, employment limits placed on people with criminal records, and the lack of job skills, transportation, child care, or good job opportunities that some people face.

In some cases, these work documentation requirements would actually make it harder for people to work because Medicaid helps them get healthy enough to work.

States that have crafted work documentation requirements assume that it will lead to thousands of people losing health coverage, despite the fact that most adults on Medicaid are actually working.

The track record of work documentation requirements in other programs suggest they do little to promote work – but they do create an “administrative nightmare” that leads to improper cutoffs of benefits.

2. Across the US, Most Adults Enrolled in Medicaid Already Work

Nationwide data show most adults enrolled in Medicaid are already working,

Those who aren't working are typically caring for young children or sick parents, going to school, coping with a serious illness or disability, or unsuccessfully looking for work already.

3. The Policy Would Be Particularly Inappropriate for Texas’ Already Bare-bones Medicaid Program

96 percent of Texans enrolled in Medicaid are people with disabilities, children, pregnant women, or seniors – not strong candidates for work requirements!

The few other Texans enrolled in Medicaid are young adults who recently exited foster care or extremely low-income parents, including homeless parents, mothers in domestic violence shelters, and others.

Work documentation requirements would presumably eliminate Medicaid coverage for those parents because they will either:

  1. fail to meet the documentation requirements, or
  2. work more hours, putting them above the income cut-off for Medicaid (a shockingly low $316 per month for a single parent with two children)

Even if these requirements lead to a few people working more, most would end up uninsured because low-wage jobs typically do not offer insurance or pay enough to allow people to buy their own insurance.

4. The New Red Tape Would Lead to Working and Eligible People Losing Health Care

Many working people (and the bureaucrats processing their forms) eventually will trip up on the new paperwork requirements and hoops to jump through — especially those people who have no car, limited access to the internet, mental or physical health challenges, and busy schedules with jobs, kids, and school.

People with more informal jobs such as in-home child care or jobs with fluctuating work hours might find it impossible to provide the required documentation.

Even if policymakers officially exempt the most vulnerable, such as those with disabilities, those individuals may not know they are exempt, may get tripped up with the paperwork, or may not meet strict definitions for exemptions.

Additionally, creating a new bureaucracy to handle this administrative side of verifying work would also be costly to taxpayers.

Want to Know More?

More information on these concerns, the background on work documentation requirements, and other concerning elements of these Medicaid proposals is available in:

Numerous additional resources, including the latest on waiver requests from other states, are available from the Georgetown University Center for Children and Families, the Kaiser Family Foundation, and the Center of Budget and Policy Priorities.