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April 11, 2018

The target of Trump's latest executive order: Work requirements—in Medicaid and beyond

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    President Trump on Tuesday signed an executive order that seeks to reform federal government assistance programs, including Medicaid, by requiring the programs' beneficiaries either to participate in the workforce or to engage in activities aimed at finding employment.

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    According to the Washington Post, the executive order represents the strongest action from Trump regarding social safety-net programs since February, when he released a federal budget proposal that called for significant cuts to health insurance subsidies, food stamps, and other benefits. Trump's budget proposal also included changes that would have reduced federal Medicaid funding by $675 billion by 2028.

    Executive order details

    Senior Trump administration officials said the executive order, titled "Reducing Poverty in America by Promoting Opportunity and Economic Mobility," aims to provide a framework for federal agencies to overhaul federal assistance programs by requiring recipients to demonstrate they either are working or are seeking employment, the Wall Street Journal reports. The executive order is intended to help more U.S. residents move away from receiving federal assistance and toward finding employment, according to Politico's "Pulse."

    The executive order targets "any program that provides means-tested assistance or other assistance that provides benefits to people, households, or families that have low incomes," including Medicaid, which covers 74 million U.S. residents. According to Axios' "Vitals," some other health care programs also might be affected by the executive order.

    The executive order directs HHS and other departments that oversee federal safety-net programs to review regulations and guidance documents for the programs and determine whether implementing work requirements would be consistent with federal law and the executive order. The order directs the departments to provide "a list of recommended regulatory and policy changes" intended to help U.S. residents enrolled in the programs move into jobs.

    In addition, the executive order directs the federal government to help state, local, and tribal partners verify whether people enrolled in federal assistance programs are in fact eligible for the programs. Eligible individuals include "any [U.S.] citizen, lawful permanent resident, or other lawfully present [individual] who is qualified to or otherwise may receive public benefits," the executive order states.

    The order gives agencies 90 days to share their findings with the White House.

    According to the executive order, the federal government in 2017 spent more than $700 billion on low-income assistance. During a press briefing, senior White House officials said recent moves by states—such as Kansas and Maine—to implement work requirements for individuals enrolled in safety-net programs demonstrate the need for the executive order. According to the White House, the average amount of time Kansas residents were enrolled in safety-net programs declined by about 50% after the state implemented work requirements for certain adult beneficiaries.  In addition, the individuals in Maine and Kansas who were enrolled in safety-net programs saw their average incomes more than double after they no longer were enrolled in safety-net programs, according to the White House.


    The executive order has drawn mixed reaction, with federal officials and some industry experts praising the step toward reforming safety-net programs, while others argued there is little evidence to support work requirements.

    Steven Wagner, acting assistant secretary of HHS' Administration for Children and Families, said, "Strengthening work requirements for welfare recipients is a critical element of moving welfare recipients from dependency to self-sufficiency." He continued, "More than just a means of income, work creates opportunities for individual growth, instills a sense of personal dignity, and leads to improved health." Wagner said HHS will release guidance and findings related to the executive order "in the coming months."

    Kristina Rasmussen, VP of federal affairs at the Foundation for Government Accountability, said, "By strengthening the work requirement for able-bodied adults on food stamps and approving states' waiver requests for Medicaid work requirements, agencies can ensure that resources are preserved for the truly needy."

    Josh Archambault, a senior fellow at the Foundation for Government Accountability, called the executive order "a great start towards another wave of reform." Archambault said, "Work requirements have proven to be an effective tool to help people make it out of poverty. You can't be on food stamps and be out of poverty by definition if you have no other earned income." Archambault said the White House might move toward standardizing rules for work requirements and eligibility across federal assistance programs.

    But Elaine Waxman, a senior fellow with the nonpartisan Urban Institute, said of the executive order, "It's a little bit of a solution in search of a problem." She added, "The administration is reflecting a larger narrative that many low-income individuals avoid work—but there's just not a lot of data to support that position. Many of these people have significant barriers to working full time."

    Sharon Parrott, a senior fellow at the Center on Budget and Policy Priorities, said, "[E]vidence shows that such requirements have few long-term positive effects on employment and often result in families losing help they need to afford the basics."

    Frederick Isasi, executive director of Families USA, said if Trump "wants to wage war on our most vulnerable families, he can expect an enormous outcry including a mountain of legal challenges and a backlash in the midterm elections" (Baker, "Vitals," Axios, 4/11; Radnofsky, Wall Street Journal, 4/10; Jan, Washington Post, 4/10; Thrush, New York Times, 4/10; Diamond, "Pulse," Politico, 4/11; Executive Order Reducing Poverty in America by Promoting Opportunity and Economic Mobility, 4/10).

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