Work Requirements For Medicaid? What About Mental Health Requirements For Welfare Benefits?

The Trump Administration has decided to offer waivers, so States can impose “work or community engagement requirements” on Medicaid recipients.  Currently, ten States have pending proposals that would allow them to deny impoverished individuals coverage under the state-run, Federally sponsored healthcare program for low-income Americans, unless they find some form of employment, engage in job seeking activities, volunteer, and/or provide care to others.  Depending on what specific requirements individual States adopt and how they verify the activities of recipients, proposed changes could help motivate select groups of individuals or create another roadblock to healthcare for low-income Americans. 

The alleged goal of the policy shift is to improve the healthcare of recipients through employment.  Although a dubious justification, which is likely to invite legal challenges, activities like employment, volunteer work, training, and caregiving do offer recipients objectives and structure, which can be good for their mental health.  Recognizing most of these eligibility requirements already exist in the US public welfare system for food stamp benefits and cash assistance, the changes are unlikely to have much of a constructive impact.  What States might consider, however, is a mental health requirement as an alternative to the employment and community engagement requirement.  That is, individuals should be fulfill the work requirement by receiving mental health services.
 
Poverty can be more adequately addressed by tackling the environmental and personal issues that prevent people from achieving financial success.  It is important to remember poverty is the result of many factors.  Dealing with the issue of poverty, therefore, requires solutions, which address all the factors that come into play.  As such, it is most important to recognize when a solution is applicable to an individual’s situation and when it is not.  After all, the wrong diagnosis will never lead to the right cure.  The right solutions must be applied correctly or it will fail.
 
This means government needs to be smarter in how it addresses poverty and social support programs, so it can actually solve the problem of increasing poverty.  Public assistance, including cash, food stamp, and medical benefits, exists to sustain the poor.  Although reforms to welfare shifted the social safety support net from a straightforward subsidy program to include what a businessman might call a “budget-enhancing” mission, America’s social programs do not adequately address the reasons these programs are needed. Because the need continues to grow along with America’s National Debt, the actual need behind public assistance must be addressed head on.
 
Simply cutting people off from public assistance and other social programs will not make the need go away while doing so will certainly damage the economy and provoke civil unrest.  Regrettably, those who push this nuclear option also tend to support “market solutions” that erroneously assume incentivizing the poor to get jobs and increasing demand for jobs by cutting the safety net will somehow lead to job creation.  Because job seekers are not job creators, the problems of the unemployed and impoverished employed cannot be solved by some “rationale choice” model that is used to justify punishing the poor and avoiding the problem.
 
Jobs exist, because employers have work that needs done.  In turn, businesses exist, because consumers demand the services and products of those businesses.  In an economically dysfunctional environment, adequate demand does not exist, demand is addressed by outside labor, i.e. outsourcing, imports, nationally sourced businesses etc, and/or the interests of the employees are not balanced with those of the employers, e.g. too low of wages. As poverty is often a geographical problem, the solution to ending dependency on government support must revolve around fixing the growing number of economically suppressed regions of the country.
 
Unfortunately, the economy has been engineered to cater to global interests by creating a lower bidder economy where cost-cutting measures, including decreased wages, tax cuts, etc, are prioritized.  Instead of building the economy to serve the needs of the people first before using the excesses of the local and national economies to participant in the national and global economies, we have an economy designed to enrich the few living in concentrated areas of the world.  Until the dysfunctional environmental factors are addressed through better tax, trade, and economic policies, poverty will remain a persistent problem that only a minority can overcome by seeking education and moving to regions that are more prosperous.
 
That said, the dysfunctional behavior of individuals also contributes to poverty.   Because mental health issues can be associated with poverty, it makes sense to provide recipients of public assistance after a set period of time, i.e. a year or two, with mental health evaluations tailored to issues associated with unemployment.  Schooling and career counselors, such as those at Pennsylvania’s CareerLink, are there to make people more functional in terms of workplace performance and job seeking, but they are not qualified to identify mental health issues that harm those facing poverty.  Frankly, public assistance caseworkers need to be better trained and empowered to help the economically dysfunctional find the help they need to address the core issues that are holding them back financially.
 
From bad habits to mental health issues, poverty both results from dysfunctional behavior and encourages dysfunctional behavior.  Certainly, education can help people learn to be more functional, which is something schools and colleges do, but emotional and psychological issues must be addressed as well.  This is not to say the poor should be criticized to death for all of their quirks and offensive behaviors as overanalyzing simply overwhelms individuals and makes them defensive.  Middle Class and wealth individuals also share many of the same kind dysfunctions.  What the poor need is help identifying what critical issues are preventing them from achieving financial success and help addressing those issues.