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Research & Commentary: Pennsylvania Considers Adding Work Requirements to Medicaid and SNAP

April 19, 2018

In this Research & Commentary, Matthew Glans examines two proposals in Pennsylvania that would impose work requirements on two safety-net programs: the Supplemental Nutrition Assistance Program (SNAP) and Medicaid.

Pennsylvania is considering proposals that would impose work requirements on two safety-net programs: the Supplemental Nutrition Assistance Program (SNAP) and Medicaid. Work requirements scale back the size and cost of out-of-control entitlement programs and reduce poverty by encouraging work and self-reliance. They have recently been enacted for Medicaid recipients in Arkansas, Indiana, and Kentucky.

One proposal would add a work requirement to Pennsylvania’s SNAP program, the fourth-largest means-tested program for low-income families and individuals. SNAP grew rapidly during (and after) the Great Recession, primarily because most states stopped requiring recipients to actively seek employment.

Prior to the Obama administration, low-income, able-bodied adults without children were limited to receiving food stamps for only three months in a three-year period—unless they fulfilled work requirements, which included employment or participation in a training or “workfare” program for at least 20 hours per week. However, between 2009 and 2010, the Obama administration approved waivers from several states abandoning work requirements. As a result, 44 percent of SNAP recipients are neither employed nor actively searching for work.

Under the Pennsylvania proposals, adults receiving food stamps would be required to work or participate in a work program for an average of 20 hours per week, perform 24 hours of community service each month, or enroll as a full-time student. The requirements would not apply to people with disabilities, pregnant women or single parents with custody of children under age 12.

The growth of SNAP is unsustainable and has been overwhelming state budgets. The focus of SNAP, and all entitlement programs, should be temporary aid for the most vulnerable while encouraging work and self-reliance.

Another proposal would attempt to slow Medicaid’s skyrocketing growth, which has placed a severe financial strain on state budgets, especially in states that expanded the program under the Affordable Care Act. Pennsylvania’s Medicaid proposal would partially address this problem by requiring the state to apply to the Centers for Medicare and Medicaid Services (CMS) requesting a waiver that would permit Pennsylvania to enact work requirements in its Medicaid program.

Under the Medicaid work requirements proposal, all able-bodied citizens enrolled in Pennsylvania’s Medicaid program would need to be employed or attend a job training program for 20 weeks or complete at least one of 12 job-related program activities every month. Sixty-four percent of American adults think childless, able-bodied adults in their state should be required to work as a condition for receiving Medicaid, according to a recent Rasmussen Reports national survey conducted online and by phone. Only 22 percent were found to disagree. Rasmussen Reports conducted the survey of 1,000 American Adults on January 14-15, 2018. The margin of sampling error is +/- 3 percentage points with a 95% level of confidence.

States that have enacted work requirements have enjoyed significant success. In Maine, able-bodied adult recipients without dependent children are required to work, participate in a work program for 20 hours per week, or do community service for about six hours per week to receive SNAP benefits. Since the reforms were implemented, Maine’s SNAP caseload quickly dropped by 80 percent, falling from 13,332 in December 2014 to 2,678 recipients in March 2015. According to The Heritage Foundation, many individuals in Maine chose to leave the SNAP program rather than participate in training or community service, which means these individuals likely had other means of supporting themselves.

Medicaid should focus on encouraging able-bodied recipients who are enrolled in welfare programs to become more self-sufficient and less dependent on government aid, not to encourage dependency on government aid.

The following documents examine welfare reform and work requirements in greater detail.
 

Research & Commentary: States Pursue Work Requirements for Medicaid
https://www.heartland.org/publications-resources/publications/research--commentary-states-pursue-work-requirements-for-medicaid?source=policybot
Senior Policy Analyst Matthew Glans examines efforts by several states to add work requirements to their Medicaid programs. “Implementing Medicaid work requirements would be a good first step for Medicaid-expansion and non-expansion states toward helping to limit the rising costs of Medicaid,” Glans wrote.

The Oregon Experiment—Effects of Medicaid on Clinical Outcomes
https://www.heartland.org/publications-resources/publications/the-oregon-experiment--effects-of-medicaid-on-clinical-outcomes?source=policybot
This article from The New England Journal of Medicine examines Medicaid outcomes in Oregon. Oregon gave researchers the opportunity to study the effects of being enrolled in Medicaid (compared to being uninsured) based on data from a randomized controlled trial, the “gold standard” of scientific research. The results showed no improvement in health for enrollees, but it did reveal better financial protections for patients and increased medical spending.

The Value of Introducing Work Requirements to Medicaid
https://www.americanactionforum.org/research/value-introducing-work-requirements-medicaid/
Ben Gitis and Tara O’Neill Hayes of the American Action Forum examine the value of work requirements and argue more work requirements are needed in other safety-net programs, including in Medicaid.

Don’t Wait for Congress to Fix Health Care
https://www.heartland.org/publications-resources/publications/dont-wait-for-congress-to-fix-health-care
Heartland Senior Policy Analyst Matthew Glans documents the failure of Medicaid to deliver quality care to the nation’s poor and disabled even as it drives health care spending to unsustainable heights. Glans argues states can follow the successful examples of Florida and Rhode Island to reform their Medicaid programs or submit even more ambitious requests for waivers to the Department of Health and Human Services, an option the Trump administration has encouraged.

Maine Food Stamp Work Requirement Cuts Non-Parent Caseload by 80 Percent
http://www.heritage.org/welfare/report/maine-food-stamp-work-requirement-cuts-non-parent-caseload-80-percent#_ftnref36
Robert Rector, Rachel Sheffield, and Kevin Dayaratna of The Heritage Foundation examine Maine’s food stamp reforms and discuss how they could act as a model for other states. “The Maine food stamp work requirement is sound public policy. Government should aid those in need, but welfare should not be a one-way handout. Able-bodied, nonelderly adults who receive cash, food, or housing assistance from the government should be required to work or prepare for work as a condition of receiving aid. Giving welfare to those who refuse to take steps to help themselves is unfair to taxpayers and fosters a harmful dependence among beneficiaries,” the authors wrote.

Welfare Reform Report Card: A State-by-State Analysis of Anti-Poverty Performance and Welfare Reform Policies
https://www.heartland.org/publications-resources/publications/2015-welfare-reform-report-card?source=policybot
In 2015, The Heartland Institute published an updated version of its Welfare Reform Report Card. This report card compiles extensive data on five “inputs” and five “outputs” of state welfare and anti-poverty programs and assigns a final grade to each state for its welfare policies.

Food Stamp Dependence in the States
http://thefga.org/solutions/food-stamps/
This interactive map from Foundation for Government Accountability shows what percentage of each state’s population is dependent on food stamps and how much it costs the state.

The Work Versus Welfare Tradeoff: 2013
https://www.heartland.org/publications-resources/publications/the-work-versus-welfare-trade-off-2013-1?source=policybot
The Cato Institute estimates the value of the full package of welfare benefits available to a typical recipient in each of the 50 states and the District of Columbia. The study found welfare benefits outpace the income most recipients can expect to earn from an entry-level job, and the income gap between welfare and work may actually have grown worse in recent years.

More States Enforce Food Stamp Work Requirements
http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2014/09/15/more-states-enforce-food-stamp-work-requirements
With the U.S. economy emerging from the recession, food stamp work requirements suspended during the downturn will be reinstated in many states, says Jake Grovum notes in Stateline.


Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News, The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database. 

The Heartland Institute can send an expert to your state to testify or brief your caucus; host an event in your state, or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Lindsey Stroud, a government relations manager at The Heartland Institute, at lstroud@heartland.org or 757/354-8170.

Author
Matthew Glans joined the staff of The Heartland Institute in November 2007 as legislative specialist for insurance and finance. In 2012, Glans was named senior policy analyst.
mglans@heartland.org @HeartlandGR