The idea is a compelling one for states that have expanded the program under the Affordable Care Act and are now faced with exploding health care costs. According to the Austin American Statesman, some Texas lawmakers would like to see that policy enacted in Texas. However, there are potential challenges that could complicate the idea in the Lone Star State.

Unlike other states, Texas declined to expand Medicaid to cover more poor people under the Affordable Care Act. The expansion was undertaken in other states to help workers who are employed part-time or otherwise are not covered by employer-provided plans. The Medicaid program in Texas tends to be limited, and most people who work do not qualify for the program if their incomes are too high. Thus, the imposition of a work requirement would have little or no effect on Medicaid in Texas.

A study reported by the Kaiser Foundation suggested that disability or chronic illness is a major impediment to employment for many Medicaid recipients, even among those who did not claim a specific disability to qualify for the program. Most proposals to impose a work requirement for Medicaid include exemptions for people with disabilities. Kaiser also found that a work requirement would involve some increased administrative costs.

This is not to say that a work requirement for Medicaid is impossible for the state of Texas. However, such a rule would have to be carefully crafted to make sure that any savings are not offset by additional costs. Any move to impose such a requirement would have to be carefully considered in the next legislative session.