Washington state should not follow the Trump administration guidance to require Medicaid recipients to work.

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The last thing Washington state should do is accept the Trump administration’s invitation to add a work requirement to Medicaid.

Contrary to an administration letter, working itself does not help improve the health of poor people. Medicaid health insurance can help ailing people get healthy enough to work.

The Trump administration sent a letter to all state Medicaid directors last week in response to ideas percolating in more than a dozen states to add a work requirement to the Medicaid program. The 52-year-old program offers free health insurance to about 70 million Americans who can’t afford it and aren’t covered at work. This new approach, advocated by some states, follows the change 20 years ago when a work requirement was added to welfare.

The Trump administration will allow states to apply for a waiver to add new work rules to their state’s Medicaid program. It’s a cynical way to shrink the number of people with government-paid health insurance. America needs more people with health insurance, not fewer.

Most health policy experts oppose the change, but polling by the Kaiser Family Foundation and Harvard Opinion Research has found that more than 80 percent of Republicans like the idea of requiring Medicaid recipients to work or train for jobs.

Besides being illogical, the Trump administration guidance on Medicaid also appears to be largely unnecessary.

Sixty percent of non-elderly adults on Medicaid already work, according to an analysis of census data by the Kaiser Family Foundation. Among those who don’t work, more than a third are ill or disabled, 30 percent are caring for young children and 15 percent are in school, according to the Kaiser analysis.

The administration’s guidance on this issue is vague enough to drive a truck through. The Trump administration advises that pregnant women and “medically frail” people should be exempt from the work requirement, but leaves the definition of “medically frail” up to the states creating their own policies.

For example, the states could decide to allow drug addicts to use their Medicaid coverage to pay for drug treatment — or require them to work, knowing that many could not, and therefore could not get the treatment to help them.


Adding a work requirement to Medicaid is mean spirited and illogical. This policy change should not be adopted in Washington state or anywhere else.