Governor proposes Medicaid work requirement pilot

Federal policy makers are revisiting the issue of work requirements for Medicaid enrollees with indications that guidelines would be coming soon. The Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma in a speech last November was highly critical of the prior legislation that expanded Medicaid to “able bodied” adults but prohibited the imposition of work requirements. The work requirements would only take effect if a state opted to pursue them and applied for a waiver from CMS. There are approximately nine states that have already submitted such waivers and are awaiting approval.

Yesterday Gov. Daugaard in his State of the State address shared that South Dakota is looking at integrating work requirements into the state Medicaid program and he would like to obtain approval for a pilot program in two areas of the state. The pilot program could impact 4,500 current Medicaid enrollees and would be structured to provide support, such as access to employment counseling, as the enrollee increases their earnings and transitions off Medicaid. A panel of stakeholders would be convened to address the required waiver. The work requirement envisioned by Gov. Daugaard would be piloted in the state’s two most populous regions: Minnehaha and Pennington counties.

The time-frame for issuance of the Federal guidelines is unclear, however, some pushback and legal challenges are anticipated. Opponents of the work requirement indicate many enrollees already work and/or have disabilities or family circumstances preventing them from working.