Medicaid Work Requirements Waiver

The Problem

The last time there was meaningful reform to entitlement programs was in 1996 when Congress passed the bipartisan Personal Responsibility and Work Opportunity Reconciliation Act (PWORA). But nearly 21 years later, the national poverty rate is about the same, yet spending on these programs has surpassed a trillion dollars. It is time to take a fresh look at what we have learned to determine the best path forward. Poverty impacts multiple generations, and in order to create a new cycle of success, we need to focus on the whole family through a two-generation approach.

The Solution

Education and employment are the two most important factors to creating cycles of success for those living in poverty. Those who are receiving government benefits, who can work, should be required to work, continue their education, or a combination of both. These reforms are necessary as we move programs forward and assist individuals in reaching self-sufficiency.

States are continuing to propose implementing cost-effective innovative solutions that improve quality and access to healthcare for low-income individuals such as health savings accounts (HSA) and direct primary care, while also ensuring accountability. There are at least 10 states waiting for federal permission to institute work requirements for their able-bodied Medicaid recipients- three of which border Tennessee. Kentucky and Indiana have both been approved. Not only will it help the individuals in moving toward self-sufficiency, but it will also save money.

What the Bill Does

The bill directs TennCare to submit to the federal centers for Medicare and Medicaid services a waiver amendment imposing reasonable work requirements upon able-bodied working age adult enrollees without dependent children under the age of six years old. If the waiver is approved, then it directs TennCare to implement the program.

More Resources

Every other state that has submitted a waiver regarding work requirements is predicting lower costs. (There are other waiver examples available as well)

See MS waiver as example:


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