Honors Program


Document Type


Date of this Version

Spring 3-11-2019


Sherwin, D. 2019. Medicaid Work Requirements: State-Based Innovation or Punitive Policymaking? Undergraduate Honors Thesis. University of Nebraska-Lincoln.


Copyright Diane Sherwin 2019.


In March 2017, officials appointed to the Center for Medicare and Medicaid Services by President Donald Trump signaled to state governments their intent to support states who would choose to utilize Medicaid’s Section 1115 waiver provision to alter their state’s Medicaid program by introducing a work requirement. As of October 1, 2018, 13 states have heeded this signal and proposed a work requirement component for their Medicaid programs. The purpose of this paper is to determine if Medicaid work requirements are an innovative policy approach to improve independence among Medicaid enrollees, or if these requirements are a punitive, partisan approach to policymaking. To study this question, I reviewed the literature about Medicaid and work requirements of other federal welfare programs, conducted an examination of several aspects of each state’s waiver application, and reviewed the results from other research and from Arkansas, the first state to implement their work requirement. After conducting this analysis, I have concluded that Medicaid work requirements are a punitive and ineffective policy approach whose purported benefits do not outweigh the difficulties they place on enrollees.