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Work Requirements Pose a Grave Threat to Low-Income Men and Women

Trump Administration Issues Guidance that Jeopardizes Access to Healthcare for Millions

January 11, 2018    

Contact: Michelle Nicolet
(P) 312.368.2675

Chicago, IL—In yet another attack on people living in or near poverty, the Trump Administration issued guidance today that encourages state governments to deny critical healthcare coverage to struggling men and women by attaching “work requirements” to Medicaid eligibility. This move violates the fundamental purpose of the Medicaid Act and threatens access to healthcare for millions of low-income Americans nationwide.

Thursday’s announcement marks the latest attempt by the Trump Administration to undermine our country’s commitment to equal opportunity for all. Alongside efforts to slash funding for Medicaid and other key anti-poverty programs through the legislative process, federal officials have signaled that they will allow state governments to drastically restrict eligibility across various public assistance programs under the guise of “welfare reform”—a racially-coded euphemism used to mask draconian cuts. Nearly a dozen states, including Kentucky, Wisconsin, Maine, and Arkansas, have submitted proposals to impose harsh and harmful policies on low-income Medicaid recipients that the Trump Administration is expected to begin approving imminently.

Medicaid work requirements are illegal. As laid out under the Medicaid Act, the core objective of the program is assisting low-income people to get medical services. Among raising other legal issues, work requirements would cause recipients to lose coverage—an outcome totally at odds with the purposes of the Act.

Work requirements are premised on the false notion that low-income adults won’t work unless forced to do so. Policymakers who promote such ideas invariably do so with barely coded rhetoric directed at people of color. These assumptions fly in the face of the fact that most low-income people who can work already do.

Work requirements do nothing to address the various barriers that prevent many low-income people from securing and maintaining decent jobs. These obstacles include very low educational attainment, chronic homelessness, a criminal record, lack of access to transportation, an undiagnosed mental illness, domestic and sexual violence, high regional unemployment rates, stagnant wages, and other structural economic forces. Many, particularly women, often have the additional burden of caregiving responsibilities for children, older adults, and people with disabilities. 

Work requirements are counterproductive. Research shows that, instead of improving employment outcomes, work requirements are more often used to kick people off of programs. By taking crucial medical, food, housing, and other assistance away from people who are already struggling, work requirements make finding or maintaining employment much more difficult.

Work requirements impose needless suffering. Work requirements are difficult to administer effectively and are often arbitrarily enforced by faceless bureaucracies, causing many low-income people to lose assistance they qualify for and desperately need. People of color, who are more likely to face structural barriers to employment and interpersonal discrimination from caseworkers, are hit particularly hard.

Everyone should have access to healthcare and other basic needs, and that access should not be conditioned on work. The Sargent Shriver National Center on Poverty Law denounces the Trump Administration’s latest attack on access to healthcare and stands ready to work with our allies and partners in states across the country to protect public assistance recipients from these and other harmful policies.

Instead of punishing people for forces beyond their control, we should be investing in the supports—like education, transportation, and training programs—necessary to help low-income adults develop the skills they need to compete and thrive. 


The Sargent Shriver National Center on Poverty Law provides national leadership in advancing laws and policies that secure justice to improve the lives and opportunities of people living in poverty. We specialize in practical solutions. We advocate for and serve clients directly, while also building the capacity of the nation’s legal aid providers to advance justice and opportunity for their clients.




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