National Civil Rights Groups Challenge Medicaid Work Requirements

National Lawyers’ Committee files joint amicus brief to oppose discriminatory employment policies encouraged by HHS.

Former Secretary of the Department of Health and Human Services Alex Azar’s implementation of new work requirements failed to consider the negative health impacts the loss of Medicaid coverage would have on women, particularly women of color, according to a recent amicus brief filed by the Lawyers’ Committee for Civil Rights Under Law, the National Women’s Law Center and Holland & Knight law firm.

“We must protect access to healthcare for women and communities of color, especially during a pandemic,” said Dorian Spence, director of Special Litigation and Advocacy at the Lawyers’ Committee for Civil Rights Under Law. “Medicaid is essential coverage that should be inclusive, equitable and upheld at all costs. While COVID-19 ravages Black and Latinx communities, unnecessary barriers to healthcare coverage could mean the difference between life and death and have to be eliminated.”

Medicaid serves as a critical lifeline, providing medical insurance coverage to hundreds of thousands of low-income people across the country. Following the passage of the Patient Protection and Affordable Care Act (ACA), Medicaid coverage was extended to thousands of additional low-income, non-elderly adults who would normally not qualify. Work requirement programs permit states to use employment as a perquisite for Medicaid eligibility and could lead to more than 600,000 individuals losing their coverage if adopted nationwide.

“Work requirements are outrageous, illegal, and founded in racist, sexist stereotypes, and must be eliminated for good. People deserve essential, often lifesaving, health coverage and shouldn’t have to fight against barriers for this vital care,” said Michelle Banker, ‎Director of Reproductive Rights and Health Litigation at the National Women’s Law Center. “Medicaid was designed to help people, and strengthen families and communities. It should live up to this mission, free from work requirements.”

According to the brief filed, Medicaid beneficiaries who do not fulfill the work requirements could lose their Medicaid coverage under the New Hampshire and Arkansas programs. In fact, over 18,000 beneficiaries in Arkansas lost their coverage when the work requirement program was in effect before the court struck it down.

The brief focuses on the devastating impact that Medicaid work requirements would have on women and communities of color, specifically Black women. These communities critically rely on Medicaid for their healthcare.

As noted in the brief, “the majority of adult Medicaid beneficiaries are women, and women of color make up well over half of women on Medicaid." The brief goes on to note that “nearly 60% of Medicaid enrollees are people of color.”

These requirements would serve as an undue burden on populations that have historically faced intersectional challenges to health care coverage, including being more likely to live in poverty and work in low-wage jobs that do not provide benefits.

Healthcare access and protections are especially critical during a global pandemic. By providing health coverage to women and their families exclusive of employment, Medicaid allows women the flexibility to change jobs, engage in job training, or make career changes that provide higher wages or better opportunities. Secretary Azar’s failure to consider how the approval of work requirements would affect coverage must be recognized and eliminated. The decision of the lower courts must be upheld to protect Medicaid access and coverage for all.