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State Governments and Judges May Moderate the Impact of the Trump Administration’s Promotion of Medicaid Work Requirements


In January 2018, the Center for Medicare and Medicaid Services (CMS) released guidance that encouraged states to submit Section 1115 waivers that impose work requirements on some Medicaid beneficiaries. To evaluate the potential impact of a policy, we need to accurately predict both how far a policy will spread and how durable it will prove over time. This commentary draws upon recent political science scholarship to describe potential constraints that changes in state-level partisan control can impose on CMS’s current waiver strategy, as well as how state-level constraints might interact with judicial review to further limit the policy’s spread.

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This work was supported in part by the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston TX (#CIN 13-413).

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Correspondence to Laura A. Petersen MD, MPH.

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The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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O’Mahen, P.N., Petersen, L.A. State Governments and Judges May Moderate the Impact of the Trump Administration’s Promotion of Medicaid Work Requirements. J GEN INTERN MED 34, 1899–1902 (2019). https://doi.org/10.1007/s11606-019-04846-6

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  • health policy
  • Medicaid
  • access to care
  • health reform