Wisconsin will begin requiring people on Medicaid to work or train for work as a condition of staying enrolled in the program, despite a legal battle in Arkansas over a similar program.
The Trump administration approved a Medicaid waiver for the state on Wednesday, with Centers for Medicare and Medicaid Services Administrator Seema Verma calling it a program to "achieve independence and self-sufficiency."
The approval came even though a lawsuit knocked down a similar provision in Kentucky and another suit is pending in Arkansas. It also arrived less than a week ahead of Election Day as Republican Gov. Scott Walker, who backed the requirements, is neck-and-neck with his Democratic challenger, Tony Evers.
Wisconsinites will need to work for 80 hours a month to maintain benefits, and if they fail to do so for 48 months in a row then they will be locked out of Medicaid for at least six months.
"This is a thoughtful and reasonable policy, and one that is rooted in compassion," Verma wrote in a blog post, noting it only applied to adults under 50 who did not have children, and didn't face difficult medical needs or certain life circumstances, such as being a caregiver, that limited their ability to work.
New Hampshire and Indiana have similar requirements.
The Trump administration did not approve Wisconsin's request to drug test all Medicaid beneficiaries.
Critics of work requirements say that they are a thinly veiled attempt to kick people off the healthcare program. Supporters say that work helps to reduce government dependency and that the program's goal should be to move people out of poverty.
“With more people working in Wisconsin than ever before, we can’t afford to have anyone on the sidelines: we need everyone in the game,” GOP Gov. Scott Walker said in a statement. “We want to remove barriers to work and make it easier to get a job, while making sure public assistance is available for those who truly need it."
Verma defended the Trump administration's stance on work or community engagement requirements in the blog post that appeared to anticipate criticisms, saying it would "not retreat from this position."
"Some believe that our sole purpose is to finance public benefits, even if that means lost opportunity and a life tethered to government dependence," she said. "Instead, what’s needed are local solutions crafted by policy makers who are closer to the people they serve and the unique challenges their communities face."
The waiver includes a requirement for certain people to pay premiums, of about $8 a month, and also to pay out-of-pocket costs of $8 when they go to the emergency room for care. Under the Medicaid program, people would undergo a health risk assessment that will include asking about drug use.
The plan will cover residential treatment for substance abuse disorder, and people will be able to reduce their premiums by making healthy lifestyle choices such as wearing a seatbelt, maintaining a healthy weight, and not smoking.
Verma praised these provisions in the waiver, saying, "As we evaluate their results, I expect these reforms may serve as a model for states looking to tackle the drivers of poor health and improve outcomes for individuals.”
Under Obamacare, states were allowed to expand government-funded Medicaid coverage to people of under specific income level, of roughly $17,000 a year, regardless of whether they are working. Medicaid otherwise covers pregnant women, people with disabilities, people in nursing homes, and children, a group that members of the Trump administration and conservatives say should remain the focus of the program.
Though the work requirements contain multiple exemptions for people undergoing treatment for addiction and for caregivers, among other groups, critics say people will be unable to keep up with the reporting requirements and become uninsured. They have said that tracking the work requirement is more expensive than healthcare coverage.
Four months into the work requirement program in Arkansas, 8,462 people were unenrolled from Medicaid after failing to log their hours online. State officials said some people had moved to another state or obtained a job, while others had failed to fulfill the requirement.
The Trump administration has supported Arkansas-style requirements, though one program was put on hold in Kentucky after a legal challenge. The Trump administration faces a similar lawsuit in Arkansas.
At least seven other states — Arizona, Kansas, Maine, Mississippi, North Carolina, Ohio and Utah — have pending requests for similar work requirements.