fb-pixelBaker rebuffs Medicaid work requirements available under Trump program - The Boston Globe Skip to main content

Baker rebuffs Medicaid work requirements available under Trump program

Governor Charlie BakerJessica Rinaldi/Globe Staff

Governor Charlie Baker is rejecting the Trump administration’s new effort to allow states to force some poor people to work to get government-funded Medicaid health insurance.

The federal Centers for Medicare & Medicaid Services announced Thursday that it is opening the door for states that want to impose work requirements on working-age, nondisabled poor people who are covered by Medicaid, a joint state-federal health care program that covers about one in five Americans.

But the Republican governor said he does not back such a move for Massachusetts’ Medicaid program, MassHealth, which covers 1.85 million poor and disabled state residents.


Although there are no current work requirements, many nondisabled adults on MassHealth do work. A spokeswoman for the state health and human services office said the number of working MassHealth recipients was not available.

“The guidance was just released and we will assess accordingly as we do with any guidance, however the administration does not support applying work requirements to the MassHealth program,” said Baker spokesman Brendan C. Moss.

Those enrolled in the program pay no deductibles and have limited out-of-pocket costs, but most do have a pharmacy copay.

Advocates cheered Baker’s response while knocking the move by the White House.

Brian Rosman, director of policy and government relations at Boston-based Health Care For All, said his group is pleased the governor “is recognizing MassHealth coverage facilitates low-income people working, and complements people’s participation in the work force.”

Meanwhile, Rosman said, the Trump administration is continuing “their ongoing war on low-income people by finding yet another reason to take away health care.”

Baker has had different views on work requirements for welfare. During his successful 2014 campaign for governor he trumpeted that, during his time as a top state official in the 1990s, he “instituted mandatory work requirement for able-bodied heads of household whose youngest child was school-aged.”


But Baker aides say health care is different, and the governor does not support mandating a direct link between access to medical care and having a job.

Federal law does not require low-income people on government health care to work. But the federal government can and does approve pilot programs of all kinds in states.

The Centers for Medicare & Medicaid Services said it has received “employment and community engagement initiatives” proposals from Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin.

The agency emphasized, however, that there are limits on which Medicaid recipients can be forced to work and how. It will, for example, mandate states that engage in a work-requirement pilot program “make reasonable modifications for individuals with opioid addiction.”

In a statement, New Hampshire Governor Chris Sununu said work requirements “offer opportunities to lifting individuals out of poverty, empower them with the dignity of work and self-reliability while also allowing states to control the costs of their Medicaid programs.”

Massachusetts has long been a leader in health care reform. Its sweeping 2006 law — signed by then-Governor Mitt Romney, a Republican — created near-universal coverage for the state’s residents. Among its key components: a mandate that every resident get health insurance.

But covering poor and disabled people in the state is expensive, and Medicaid costs have consumed a larger and larger percentage of the state budget in recent years, meaning there is less money to spend on other areas, such as education and transportation.

Currently, Medicaid expenditures represent about 40 percent of the state’s $40 billion budget, although Massachusetts will be reimbursed by the federal government for perhaps half of those costs. State spending on MassHealth has doubled since 2007.


Joshua Miller can be reached at joshua.miller@globe.com.