Humanizing Work Requirements for Safety Net Programs

Abstract

This Article explores the political and policy appeal of work requirements for public benefit programs and concludes that inclusion of such requirements can be a reasonable design choice, but not in their current form. This Article’s proposals attempt to humanize these highly controversial work requirements while acknowledging the equity concerns they are designed to address. Drawing on expansive definitions of “work” found in guidance published by the Centers for Medicare and Medicaid (“CMS”) and in various state waiver applications, this Article proposes that work requirements be approved for Medicaid (as well as other benefit programs) only if they encompass various forms of unpaid but intrinsically valuable activities. This Article also proposes that the requirements be converted from a punitive eligibility precondition that can result in the termination of Medicaid coverage into an incentive program. To incentivize people to engage in “work” activity, this Article proposes that any activity engaged in for purposes of Medicaid (or any other benefit program that utilizes similar work requirements) count as earned income for purposes of the Earned Income Tax Credit (“EITC”) and also count toward quarters of coverage for purposes of the Social Security and Medicare programs. This design would incentivize lower income individuals to work or engage in socially-valuable activities, could strengthen popular support for Medicaid by incorporating social insurance features, and would help address the longstanding problem of valuing socially important unpaid work such as caregiving.