National Review

Getting to Work in Maine

Nic Horton, Founder & CEO
October 16, 2017

The state of Maine has long been on the leading edge of welfare reform. Under Governor Paul LePage, it has reformed its food-stamp program by promoting work, resulting in former enrollees’ more than doubling their incomes the following year. Maine has also worked tirelessly to find and prosecute welfare fraud, going after those who steal limited resources from the people who most need help.

These efforts, combined with Maine’s rejection of Obamacare’s Medicaid expansion, have allowed the state to make the truly needy a priority. But Maine’s not slowing down.

In August, the state submitted a Medicaid-reform waiver to the Trump administration. If approved, the waiver will allow the state to make several important changes to its Medicaid program — asset tests, premiums, and allowing providers to charge enrollees for missed appointments. But of all the proposed reforms, none are as important or transformational as work requirements.

Maine’s plan would generally require able-bodied, working-age adults (ages 19 to 64) to work or participate in a work program for 20 hours per week to maintain Medicaid coverage through MaineCare. Able-bodied adults could also fulfill the work requirement by volunteering, by being enrolled in school at least half-time, or through a few other avenues.

In addition, the waiver proposes some reasonable exemptions for individuals in rehab, caretakers of children under age six, pregnant women, and those who are “physically or mentally unable” to fulfill the work requirement, as determined by a medical professional.

Mirroring common-sense food-stamp rules, enrollees would be allowed to stay enrolled for just three months out of any 36-month period without meeting these work standards.

Maine’s reform, when approved by the Trump administration, will be historic. To date, work requirements have not been allowed in Medicaid, despite their prevalence in food stamps and cash welfare. But for many Mainers who are trapped in the welfare system, work requirements are exactly the hand up they need.

After the state reinstituted food-stamp work requirements, incomes more than doubled, caseloads plummeted, and limited resources were immediately freed up for the truly needy. There’s plenty of reason to believe that Medicaid work requirements will produce a similar life-changing experience for Mainers.

But perhaps most important, consistent with the state’s broader reform portfolio, this is simply the latest step towards restoring Maine’s welfare system as a safety net for those who actually need it.

Maine has already made significant strides in this area, increasing funding for nursing facilities by 40 percent, increasing home-care reimbursement rates by 60 percent, and investing $100 million toward the needs of individuals with intellectual and developmental disabilities. With Medicaid work requirements in place, they’ll be able to do even more for the vulnerable.

Maine’s latest push comes at just the right moment. Under Governor LePage, the state has seen its lowest unemployment rate in 40 years; there are jobs available for those who need to move from welfare to work. All Maine needs is final sign-off from the Trump administration, which seems likely. The administration has repeatedly signaled its desire to work with states to reduce dependency, and after years of grappling with skyrocketing welfare costs, largely because of the pro-welfare policies of the last administration, states are rushing to take them up on the offer.

By fast-tracking Maine’s waiver — and similar Medicaid waivers for Wisconsin, Arkansas, Ohio, Kentucky, and Indiana — the Trump administration can help individuals out of the welfare trap, free up limited resources for the truly vulnerable, and send a clear message that a new era of welfare reform is finally here.


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