Why Medicaid work requirements aren't the same as welfare reform

A mother on Medicaid in Kentucky plays with her daughter
Teresa Loman of Erlanger, Kentucky, who works two part-time jobs and is worried about Medicaid work requirements, draws with her daughter, Leona Hunter. Photo: Carolyn Van Houten / The Washington Post via Getty Images

The Medicaid “community engagement” waiver awarded to Kentucky, and similar waivers expected to be awarded to at least eight other states, are viewed by both advocates and critics as a form of "welfare reform" for Medicaid. They require that beneficiaries work or take steps towards work in return for Medicaid coverage.

Reality check: But they do only half of what the 1996 welfare overhaul did. They provide no new federal funding for job training, job search, transportation, child care or the other support services that were the government’s part of a new two-way bargain with beneficiaries. And without that two way street, what they will mainly accomplish is to reduce the Medicaid rolls by erecting barriers to coverage.