Adding work requirements to Medicaid isn’t a bad idea

Over the past 46 years that I’ve been part of America’s job training system, work requirements for government benefits have been proposed several times.

Each time these work rules have been initially denounced by opponents as “cruel,” “punitive,” “blaming the victim” — with accompanying fears that benefit recipients were not ready to be employed and would lose needed benefits. Yet each time work requirements have been implemented, they have resulted in increased employment and other life benefits for a significant segment of participants, their families and local communities. Those are the metrics by which to measure success; reducing the rolls of benefit programs has not been the main goal sought by advocates of previous work requirements.

The results have been documented over the years by scholars representing a range of viewpoints: Harry Holzer of Georgetown, Lawrence Mead of New York University and the professional research staff at MDRC, to cite a few. These results have been seen with work rules imposed for welfare recipients, recipients of various General Assistance benefits and parents who owe child support. They will be seen again if the proposed Medicaid work rules go forward and are implemented seriously and with purpose.

Individuals on welfare and other benefit programs often need a push into the job world. They may lack confidence, have become discouraged or have no idea how to get started. Work rules provide that push. They also provide a support network for job placement and retention.

America Works is one of the nation’s largest job agencies serving unemployed people, referred by various government benefit programs. Each participant is assigned a job counselor and develops an individual employment plan. The counselor is to identify job openings, assist the participant in applying, advocate for the participant to employers. The counselor is also trained to be the coach whom all job seekers need: keeping spirits up through the (likely many) rejections, serving as a problem solver during the placement process and troubleshooting when job issues inevitably arise after placement. At each stage, the participant is no longer on their own.

Since the early 1980s, work rules have been most extensively tested, studied and monitored in the welfare system, first as pilot projects by individual states and later under the federal welfare reform of 1996. Welfare scholars of the 1980s, including Manpower Demonstration Research Corp. President Judith Gueron would highlight how much previous welfare policies divorced from work requirements had underestimated the work orientation and strengths of welfare recipients. Researchers of welfare-to-work programs of the 1990s and early 2000s at the Urban Institute and with a consortium of university centers would confirm the widespread work orientation of welfare recipients, as well as their abilities to function in the work world.

This is not to romanticize welfare-to-work. Despite the counseling and supports (transportation subsidies, child-care subsidies), a good number of participants drop out during the placement process or within a year of job placement. They do so because of chaotic personal lives or mental illnesses or developmental disabilities that the job placement system is unable to address. They do so because of an absence of a family network, or because they don’t want to risk the other housing, healthcare and food stamp benefits they receive beyond the welfare payment. Even those who obtain jobs often struggle economically.

At the same time, for those who are able to maintain a job, the job frequently brings values beyond the income. Jason Turner, the architect of the early Wisconsin welfare-to-work successes and later commissioner of New York City’s Human Resources Administration, references the power of the job, drawing on his experiences over four decades. A job brings structure to participants in work requirement programs, somewhere to go every day. It brings a new confidence, which can translate into addressing daily life responsibilities that previously seemed overwhelming.

In theory, the importance of employment is hailed across the political spectrum. In practice, though, the ties of government benefits to employment have been weakened in the past two decades — and so many opportunities to demonstrate the value of this connection have been missed. Welfare-to-work requirements have been diluted in major cities and blue states. Employment efforts for recipients of Supplemental Security Income and Social Security Disability Insurance have stalled. Guaranteed incomes schemes removed from employment have gained currency.

The current proposed Medicaid work rules exclude Medicaid recipients with disabilities, mental health conditions and adults with young children. They also exclude the large number of Medicaid recipients who work part time or full time. None of these Medicaid recipients are at risk of losing health benefits.

For the remaining group, the “able-bodied” without young children, America has a vast workforce network at the ready to provide job placement services. No new bureaucracy is needed. It is a network of community-based agencies, workforce intermediaries and local American Job Centers, with lengthy experience in placing workers who have been outside the job mainstream. Though the first jobs that Medicaid recipients obtain will mainly be entry-level, lower-wage jobs, the recipients will be better off economically and at least on a path to the workforce system’s goal of “a job, a better job, a career.”

Medicaid work rules are not cruel or punitive. They help Americans to reclaim the power of the job.

Michael Bernick, a former director of the California Labor Department, serves on the state’s Behavioral Health Oversight Commission.