How the Trump administration is reshaping Medicaid

AMERICAN lawmakers are acutely afraid of rewarding the loafing poor. For that reason, Congress has set strict work requirements on federal food assistance and cash welfare. The Trump administration is now steadily doing the same for Medicaid, as America’s health-insurance programme for the poor is known. On January 11th the Centres of Medicare and Medicaid Services (CMS) issued a memo inviting states to apply for waivers that would include “work and community engagement requirements” on the theory that this would both improve health and help families “rise out of poverty and attain independence”. Ten states, all Republican-led, quickly took up the offer. Michigan, another Republican-controlled state, has contemplated a waiver of its own which would impose some of the strictest work requirements yet seen. The impetus is less financial than moral—an attempt to sort the deserving poor from the chaff.

The state proposals to reform Medicaid are fairly similar. Exempting the pregnant, disabled and others, all adults would have to work, volunteer or undergo job training to continue receiving benefits. Kentucky, the first to send a plan to CMS, set the minimum at 20 hours per week. Michigan had proposed 29 hours per week. After one warning, those who failed to meet the requirement would be locked out of coverage for a year.