Work in exchange for Medicaid?

Should those receiving public benefits be required to do anything in return? It’s not a new question, but one that is resurfacing today.

There is some historical precedence to the concept. In II Thessalonians 3:10, the Apostle Paul wrote: “Anyone unwilling to work should not eat.” Captain John Smith told the Virginia colonists: “… that he that will not work shall not eat (except by sickness he be disabled)…” During the Great Depression, agencies like the PWA and WPA gave people assistance in exchange for doing public work. In 1996, President Bill Clinton signed the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 that required work from able-bodied individuals in exchange for government benefits.

In North Carolina those who receive SNAP assistance (formerly known as food stamps) and are considered able-bodied adults without dependents must satisfy the requirement of working at least 80 hours a month, participating in a qualifying education or training program, or volunteering for unpaid work in a qualified state-approved charitable endeavor.

President Trump, believing he had killed Obamacare, has proposed to allow special waivers to state Medicaid programs to allow requirements similar to the SNAP guidelines. For the record, Obamacare is not dead in our state, as some 524,000 signed up for the insurance in 2018. North Carolina had already applied to the Center for Medicare and Medicaid Services for a waiver similar to Trump’s proposal as part of our Medicaid reform application.

We are told a possible compromise may have been reached between Gov. Cooper and Republican leadership in the legislature. It would allow as many as 400,000 new recipients into our Medicaid program, a move our Republican-led legislature has steadfastly refused to consider. In exchange, Cooper and the administration would institute the provisions of work, education or volunteering. This would not include the 2.1 million already enrolled, just new recipients.

The numbers of those required to work, study or volunteer would be much less than the 400,000 projected additions. As with SNAP, seniors, children and those with disabilities would be exempt from the requirements; some estimate the real number who would qualify as able bodied might be as low as 100,000. The state would be required to pay 10 percent of the costs for all new recipients.

Is this is a good compromise for our state and for those who might receive Medicaid? We would give it a qualified yes. But the devil is always in the details and many questions need answering. Who makes the determination someone is able bodied? Will we be creating even more bureaucracy in administering such a program? How much and who would be allowed flexibility in decisions? What will be the true savings and costs to our state? Finally, can our state, about to embark on major Medicaid reforms, efficiently add yet another wrinkle to a complicated program?

For the moment, we applaud Gov. Cooper and Republicans for their willingness to compromise to achieve results and hope it is a sign of things to come.

We profess a willingness to help those who either cannot help themselves or are helping themselves, but still need assistance. We also believe it fair to ask those who can work to do so if they receive public assistance.

Tom Campbell is former assistant North Carolina State Treasurer and is creator/host of NC SPIN, a weekly statewide television discussion of NC issues. Contact him at

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